Airport pollution linked to acute health effects among people with asthma in Los Angeles

by Wendy Gutschow

A recent research study by Dr. Rima Habre took a detailed look at the short-term health impacts caused by breathing in ultrafine particulate (UFP) matter that is emitted from aircraft activity at the Los Angeles International Airport (LAX). Several years ago, USC researchers identified a clear pattern of UFP emissions from takeoff and landing aircraft activities at LAX. Levels of the dangerous UFPs were found to be 4 to 5 times greater than background levels in downwind communities.  “Ultrafine particulate matter is known to contribute to reduced lung function, and airway inflammation in individuals with asthma. We wanted to take a close look at short term effects on health when individuals breathe air that contains UFPs from airplanes,” said Habre. The study participants were made up of adults with doctor diagnosed asthma.

Rima Habre holds an ultrafine particle monitor monitor while a plane flies overhead. Photo courtesy of Something in the Air documentary.

Dr. Rima Habre has been with USC for five years. Dr. Habre’s expertise lies in air pollution exposure assessment, analyzing patterns of how people get exposed to air pollution across time and space and studying how specific pollutants impact their health.  

Recently Dr. Habre’s work reached the international stage through a documentary, produced by the Canadian Broadcasting Company, called Something in the Air.  “The producers were very interested in learning more about our latest work around air pollution and asthma – specifically around the latest technologies we are using to better understand the impacts of small particles on a personal level – in children and adults with asthma, and in pregnant women.” Dr. Habre was interviewed about her work around ultrafine particle exposures downwind of major airports and its effects on asthma, as well as her work to understand how children’s personal exposure to air pollution predict their risk of experiencing an asthma attack. Something in the Air will be released this week in Canada, with an international release to be announced.

Airport-related ultrafines affect health differently than traffic-related ultrafine particles

Habre and her team designed this study to test the short-term effects of breathing ultrafine particles by asking study participants to walk in a Los Angeles park located within the known higher levels of UFPs emitted from airplanes and near heavily trafficked roads, and another park farther away from the airport and busy roads with lower levels of UFPs.

The map above shows the two parks where the study took place. The grey shaded area shows the approximate location of the plume of ultrafine particles created by air traffic around LAX, that usually occurs when the winds are blowing steadily from the West.

“In our study, we found that inhaling UFPs led to higher inflammation in the blood in adults with asthma shortly after exposure. However, different inflammation markers responded to aircraft-related versus traffic-related UFPs – both of which are major ultrafine particle sources in dense urban areas. We were able to see these different signals because we managed to overcome the challenge of separating the air pollution mixture into its major sources using sophisticated measurements and modeling techniques,” said Habre.  The pollutants measured by the study included UFP particle number, particle size, black carbon, carbon dioxide, particle-bound polyaromatic hydrocarbons, and ozone.

The significance of Habre’s study is that in such a short time, following regular walking exposure and a higher exposure, they were able to see significant elevation in inflammation systemically, not just in the lungs but in the overall blood circulation. Inflammation is tied to a lot of disease processes; cardiovascular, respiratory, and metabolic. “We don’t know specifically what this inflammation will lead to down the line, but we know that inflammation is generally a bad thing, and will complicate or exacerbate existing conditions. Ideally, we would have liked to have been able to monitor people long-term to see if that inflammation persists or if it goes down after a while but we were not able to do that in this specific study, that’s a future direction of this research I’d like to look at,” said Habre.

When asked what this research means to the overall population, Habre described the current body of research that has found ultrafine particles to be much more toxic than the larger sizes of particulate matter, UFPs are not regulated, and UFPs impact large numbers of people who live in communities surrounding airports.

Ultrafine particulate matter research: future directions

Dr. Habre also leads environmental exposure assessment efforts in multiple research studies being conducted at USC, including the MADRES study of pregnant women and babies and the LA DREAMERs study of children’s health across the life course, and in partnership with other research groups such as the Los Angeles PRISMS Center, a UCLA/USC partnership.  Her work in the Los Angeles PRISMS Center is taking a deeper dive into the different sources of air pollution asthmatic children encounter in their day to day lives in Los Angeles and how it impacts their health.  This study focuses on personal experiences, using Bluetooth-enabled wearable sensors to monitor environmental exposures, location, activity, medications and symptoms, to ultimately generate new information to help predict and prevent asthma attacks. To learn more about the Los Angeles PRISMS Center, watch this video: https://www.youtube.com/watch?v=-m72NkwolgU&feature=youtu.be

As she moves forward with her research on the health effects of ultrafine particulate matter in urban areas, Dr. Habre plans to build on her current work by studying how people with asthma are affected, as well as those who are obese, have diabetes, or cardiovascular issues. “I would like to be able to capture a wider variety of sources of ultrafines in urban areas and also be able to monitor individuals for a longer period of time to really understand what happens next. In this study we saw very quick and acute effects, but do people tend to recover after a day? I think the ultimate goal would be to really understand if people living in these high exposure locations, for extended periods of time, and breathing this mixture in regularly are at a significantly higher risk or not,” she said.


For more information on the “Something in the Air” documentary that Dr. Habre’s work is featured in, on the documentary’s website: www.somethingintheair.ca. Once the documentary is released in the United States, USC Environmental Health Centers will publish the release date and viewing information.

Rima Habre, Hui Zhou, Sandrah P. Eckel, Temuulen Enebish, Scott Fruin, Theresa M. Bastain, Edward B. Rappaport, and Frank D Gilliland, 2018. Short-term effects of airport-associated ultrafine particle exposure on lung function and inflammation in adults with asthma. Environment International. https://doi.org/10.1016/j.envint.2018.05.031

Funding: This study was funded by the Southern California Environmental Health Sciences Center (National Institute of Environmental Health Sciences, P30ES007048) pilot program, NIEHS grants 1R01ES023262, 1K22ES022987, 1R01ES027860, and the Hastings Foundation.

USC and partner institutions awarded $6 million children’s environmental health grant from NIH

Research to look at prenatal and early life environmental influences on lifetime health related to asthma and obesity

Staff Report

Media Coverage: Press Enterprise, Daily News, The Washington Times, Redding.com, Daily Breeze, Pasadena Star News

LOS ANGELES – September 21, 2016 – Researchers at the Keck School of Medicine of USC have been awarded a 2 year $6 million grant, as the first phase of a large seven-year National Institutes of Health, Environmental Influences on Child Health Outcomes (ECHO) initiative involving more than 30 research entities. The USC based research team will investigate health issues related to asthma and obesity. Continue reading “USC and partner institutions awarded $6 million children’s environmental health grant from NIH”

New Research published from the CHS: Less pollution = improvement in children’s respiratory health

Bronchitic symptoms on the decline as pollution levels drop in Los Angeles region over the past two decades  #CleanAir

PRESS COVERAGE: Press Enterprise, New York Times, U.S.News, HealthDay, United Press International, Medical News Today, Eureka Alert
JAMA Coverage:  News Release and VideoAuthor Interview Video
Storify: Press and social media coverage of this study all in one place.

A USC study that tracked Southern California children over a 20 year period has found they now have significantly fewer respiratory symptoms as a result of improved air quality.

The finding expands on the landmark USC Children’s Health Study, which a year ago reported that kids’ lungs had grown stronger over the past 20 years as pollution levels in the Los Angeles Basin declined. In the current study, USC researchers examined a health issue that makes many parents anxious while pulling at their pocketbooks: bronchitic symptoms that could land otherwise healthy children in a doctor’s office or hospital.

The research appears in the April 12, 2016 issue of the Journal of the American Medical Association.

To assess respiratory symptoms, USC scientists studied children in eight California communities and defined bronchitic symptoms over the preceding year as a daily cough for at least three consecutive months, congestion or phlegm not related to a cold, or inflammation of the mucous membranes, according to Kiros Berhane, lead author and a professor of preventive medicine at the Keck School of Medicine of USC.

“This is one of the few times that we have been able to report good news, and this is very likely a direct result of the science-­‐‑based policies that have been put in place,” Berhane said. “The message that clean air leads to better health in children should be taken seriously because it has implications for how we live and how productive we become.”

The study, published April 12 in the Journal of the American Medical Association, followed 4,602 children in three cohorts as they aged from 5 to 18. During 1993 to 2012, children and their parents from Long Beach, San Dimas, Upland, Riverside, Mira Loma, Lake Elsinore, Alpine and Santa Maria answered questionnaires about children’s health. Air quality was continuously monitored in each community.

“Because of the wide variations in ambient pollution levels among the eight California communities we analyzed, these findings are applicable to other parts of the United States and maybe other parts of the world as well,” Berhane said, adding the results could help with asthma management and the overall respiratory health of children.

How much children’s respiratory health improved

Because bronchitic symptoms are usually about four times higher in children with asthma, the scientists examined associations of air pollution reduction with bronchitic symptoms separately for kids with and without asthma. Researchers also adjusted their analyses for age, gender, race or ethnicity, secondhand tobacco smoke and presence of cockroaches in the home.

“It is important to note that while reductions in bronchitic symptoms were larger in children with asthma, they were still substantial and significant in children without asthma as well — indicating that all children have benefited from the improvement in air quality over the past 20 years,” Berhane said.

The study found that tiny particles called particulate matter 2.5 (PM 2.5) — which can penetrate deep into lungs and cause serious health problems — dropped by 47 percent from 1992 to 2011 in the study region. USC researchers were able to associate cleaner air with improved children’s respiratory health. Kids with asthma were 32 percent less likely to suffer from bronchitic symptoms, and children without asthma experienced a 21 percent reduction in these respiratory problems.

Moreover, nitrogen dioxide, which can reduce resistance to respiratory infections, decreased by 49 percent in the same two decades. USC researchers linked the drop in nitrogen dioxide with a 21 percent decrease of bronchitic symptoms in children with asthma and a 16 percent decline of bronchitic symptoms in kids without asthma.

“This type of data is important for policymaking and for how clinicians would advise their patients,” Berhane said.

The cost of asthma and sick children

About 1 in 10 children in the United States had asthma in 2009, according to the Centers for Disease Control and Prevention. Medical expenses associated with asthma amounted to $50.1 billion in 2007 and cost the nation about $3,300 per person each year.

“Changes in children’s respiratory health have a ripple effect,” Berhane said. “A child may stay home because of severe bronchitic symptoms. That could mean parents have to call in sick or arrange for a caregiver. Beyond quality of life, childhood asthma and bronchitic symptoms take a toll on children’s school attendance, parental productivity and society in general.”

Asthma is the cause for almost 2 million emergency room visits each year, according to the Asthma and Allergy Foundation of America. Each year, this respiratory condition is the reason for more than 14 million doctor visits and about 439,000 hospital stays.

Frank Gilliland, senior author and a professor of preventive medicine at Keck Medicine of USC, said the USC Children’s Health Study is a unique examination because it has been able to follow children for so many years.

“Asthma is the most common chronic disease of childhood, so the reduction of these symptoms by 16 to 32 percent is a big deal,” Gilliland said. “We studied longitudinal cohorts of children for 20 years using consistent methods and found that decreased levels of air pollutants were associated with a marked decrease in bronchitic-­‐‑related symptoms in children both with and without asthma. No other study has been able to accomplish this.”

Pollution and policy

California cities have consistently topped the American Lung Association’s annual list of most polluted cities by ozone or particulate matter pollution. Historically, Southern California has reported high levels of ambient air pollution because of emissions from vehicles, industrial sources and two of the nation’s largest ports.

“While the reduction in ambient air pollution has been observed during the past 20 years, it was most marked after 2000 and is very likely due to policies that were put in place,” Berhane said. “Even though this is very encouraging, there is still room for improvement. We must recognize that in some cases, the ozone and particulate matter levels in Southern California are still in violation of federal standards.”

Some California regulatory policies that have been implemented include the Low-Emission Vehicle Program, a risk-reduction plan for diesel fueled engines and vehicles, and pollution controls at the ports of Los Angeles and Long Beach.

For many years, environmental epidemiologists have reported adverse health effects associated with increasingly polluted air. So the ability to report that Southern California has been on the path to cleaner air and that this reduction in air pollution has led to significant improvement in children’s health is a welcome change, Gilliland said.

Berhane added: “But we must not get complacent. We expect more cars on the road, more ships at our ports and more economic activities in the region. Even if we maintain the current policies and practices in environmental protection, pollution levels could start to rise again because of more cars and economic activities. We have to stay vigilant so that we do not lose current gains in air quality and the associated improvements in our children’s health.”

USC strives to conduct research that could have a global impact. This study was supported by the National Institute of Environmental Health Sciences, the Health Effects Institute and the California Air Resources Board.

Press Release: by Zen Vuong, USC Media Relations

# # #
Kiros Berhane, PhD; Chih-Chieh Chang, PhD; RobMcConnell, MD;W. James Gauderman, PhD; Edward Avol, MS; Ed Rapapport, MPH; Robert Urman, PhD; Fred Lurmann, MS; Frank Gilliland, MD, PhD. Association of Changes in Air Quality With Bronchitic Symptoms in Children in California, 1993-2012. JAMA. 2016;315(14):1491-1501. doi:10.1001/jama.2016.3444

SCEHSC Center members involved in KPCC Story: More than 150 LA child care centers dangerously close to freeways

Local KPCC reporter, Deepa Fernandez (Early Childhood Development Correspondent) approached SCEHSC staff and researchers last year to inquire about air pollution monitoring and health effects of near roadway air pollution on children. Today her feature story about childcare centers in Los Angeles in close proximity to freeways was published.We are proud to not only have our center members quoted in the story, but community partners as well.

Deepa Fernandez, KPCC

Culver City writer Tracey Moore loved everything about her daughter’s daycare. It was close to her family’s house, included some Spanish immersion, and her young child was smitten with the staff.

So when the owner informed parents she was moving, there was unanimous consensus among families that they would all follow her.

But when Moore saw the new daycare location, she was devastated: “It’s a side street that dead ends right at the freeway,” she recalled, “and the preschool is about a stone’s throw [away].”

Every day, more than 300,000 cars and trucks rumble through that section of the 405, according to CalTrans data for 2014 – making it one of the most highly-trafficked spots in Los Angeles. Moore didn’t know that specific statistic, but she could see the traffic and was concerned about what she called the “invisible ribbon of particles” drifting off the freeway from cars and trucks directly into the yard of the day care. Read more here

Map: Where child care facilities are next to highways

Common genetic variation safeguards children from asthma

Genetic protection for lung inflammation vanishes when children constantly breathe in high-traffic pollution

by Zen Voung, USC Media Relations
Link to original article on USC News

Too much residential traffic removes the protective effect a specific gene has on lowering asthma risk, according to a new USC study.

Children could have zero, one or two copies of a common gene variant. Continue reading “Common genetic variation safeguards children from asthma”

USC News: USC, UCLA to develop children’s asthma prediction app

Technology will help young people maximize their health and reduce the burden of the incurable condition

by Zen Voung, USC Media Relations
Link to original article on USC News

USC and UCLA scientists are working on a smartphone app and cloud services platform that will predict the probability of a child’s future asthma attack and provide personalized risk management advice.

The smartphone is a personalized approach that evaluates potential real-time environmental triggers. (Graphic/Alex Bui)

Frank Gilliland, professor of preventive medicine at the Keck School of Medicine of USC, said the integrative Biomedical Real-Time Health Evaluation (BREATHE) platform he and colleagues are developing is a potentially revolutionary approach to managing asthma, one of the most common chronic childhood diseases.

“We think this is the future for asthma care,” said Gilliland, co-principal investigator of the project. “We will use real-time, high-volume information about physiology, symptoms, medication use and environmental exposures. This ‘big data’ will help physicians manage patients better and prevent exacerbations. It is a personalized medicine approach that evaluates potential real-time environmental triggers, genetics and a child’s asthma attack

Data crunch
USC and UCLA researchers will build a platform that will crunch data from children’s wearable devices, smartphones and individual electronic health records as well as real-time reports on weather conditions, air quality, pollen and allergy forecasts, and other “asthma triggers.” The algorithm will supply contextual information in a secure, cloud-based system.

The National Institute of Biomedical Imaging and Bioengineering awarded a $5.25 million grant to co-principal investigators Gilliland and Jose-Luis Ambite, a research assistant professor in the Department of Computer Science at the USC Viterbi School of Engineering. The agency also awarded UCLA a $6 million grant, of which $1.85 million is expected to be subcontracted to USC. The money in both grants will be spread across four years of research and development.

About 6.8 million children in the United States have asthma, according to the Centers for Disease Control and Prevention. The currently incurable respiratory condition cost the United States about $56 billion in medical costs, lost school and work days in 2007.

“Asthma weighs heavily on the nation in terms of public health, medical costs and quality of life,” said Alex Bui, also a principal investigator in this study and professor of radiological sciences at the David Geffen School of Medicine at UCLA. “One of the biggest challenges will be making the smart device user-friendly for young children. Kids like intuitive interfaces with bright colors, simple language, big text and quirky noises. We’re having fun exploring how to build those facets into our design.”

Take a breath
Researchers will test the platform on 8- to 12-year-old children with asthma. The algorithm scientists are developing will analyze data from the landmark USC Children’s Health Study, a litany of contextual data from environmental sensors and a history of previous asthma attacks. When exacerbating conditions arise again, the asthma app may remind a child or caregiver to bring an inhaler or medicine to ward off a future asthma attack.

“We will use technology to help people maximize their health and reduce the burden of childhood asthma,” said Gilliland, director of USC’s Division of Environmental Health. “Privacy is critical. The data has to be encrypted and secure so people could be assured their data will be confidential.”

The smartphone is a personalized approach that evaluates potential real-time environmental triggers. (Graphic/Alex Bui)

Southern California Children’s Health Study Forum

The Southern California Children’s Health Study Forum: “Healthier kids and the future of cleaner air” was a chance for researchers to talk about the latest information about air pollution in the Los Angeles basin, and what this means for children’s health.  Community leaders discussed their work to reduce emissions from freeway pollution and the ports in the future.

Thank you to all the speakers and participants at the May 18, 2015 event in Long Beach, CA; nearly 100 residents and members of nonprofit organizations attended.

The event featured panelists Frank Gilliland, Rob McConnell, Ed Avol, and Jim Gauderman of USC, mark! Lopez, East Yard Communities for Environmental Justice, Elisa Nicholas, Long Beach Alliance for Children with Asthma, and moderator Andrea Hricko, USC.  Panelists discussed recent research, including studies on overall levels of air pollution and improving children’s lung function, studies linking air pollution exposure to higher weight and obesity, and the health costs of air pollution to families.  Levels of ultrafine particles, the smallest particles that can get deep into the lungs, are still too high near roadways and downwind of LAX Airport.

Residents were able to talk with USC scientists about their environmental health concerns, and discuss how to use research results in the future.  Participants brought up many important issues, and talked about ways in which the community and researchers can partner together.

“Building partnerships and opportunities for youth to go on to these career paths is important.”
– East Yard Communities for Environmental Justice

“I can’t tell you how many times I’ve quoted the Children’s Health Study.”
– Long Beach Alliance for Children with Asthma

“The work you’re doing here in LA is also helping people 1500 miles away.”
– Diesel Health Project, Kansas City

Panel of speakers at the forum.

Over 100 people attended.

Organized by the Trade, Health, and Environment Impact Project, and sponsored by the Southern California Environmental Health Sciences Center, the Southern California Children’s Health Sciences Center, Building Healthy Communities: Long Beach, and The Kresge Foundation.