Spontaneous pneumothorax and ozone levels: is there a relation?

Abstract

Study objectivesAlthough links between meteorological conditions and spontaneous pneumothorax (SP) have been proposed, the reports are controversial. In this study ozone levels, which are known to have some adverse effects on lung tissues, were investigated as a potential triggering factor of SP. At present there is not sufficient information about the effects of ozone on SP.MethodsOf a total 79 pneumothorax patients recruited for the study, 21 secondary pneumothorax cases were excluded. In the remaining 58 SP patients, meteorological data at the time of SP occurrence were recorded.ResultsThe number of SP patients was higher in spring than in the other seasons (p < 0.05). There was an association between the SP frequency and the average ozone level at different seasons (F 3,52 = 19.45, p = 0.001). The average ozone level was higher in spring (363 ± 25 Dobson) than during the other seasons (autumn 296 ± 18 Dobson; summer 321 ± 26 Dobson; winter 324 ± 32 Dobson) (p = 0.001). There was a positive correlation between SP frequency and the average ozone values for each season (r = 0.301, p = 0.024). There was no significant correlation between the severity of SP and ozone level (r = 0.236, p = 0.16).ConclusionsThe number of SP patients increases in spring when ozone levels are highest. Ozone is known to affect alveolar cells and cause interstitial edema. Ozone causes damage to the lung interstitium by way of oxidative stress. Rupture of unrecognized underlying blebs/bullae has been proposed as a cause of SP. Increased levels of ozone may be a triggering factor for these ruptures.

Incidence of primary spontaneous pneumothorax is not associated with microclimatic variations. Results of a seven-year survey in a temperate climate area

“…A universally agreed explanation is lacking, however. Some previous studies described a slight prevalence of SP episodes during springtime [24], peaking during maximum dissemination of pollens [25], as well as during atmospheric increase of nitrogen dioxide (NO 2 ) and ozone (O 3 ) [26,27]. Nevertheless, additional reports reached different conclusions, showing peaks of SPs during wintertime, in particular from November to February, and linking these findings with an increase in viral upper airways infection [25,28].…”

Do Meteorological Changes Have an Effect on The Occurence of Spontaneous Pneumothorax?

“…Changes in air composition such as higher concentrations of ground ozone levels in addition to heat waves and extreme meteorological events may fluctuate and cause respiratory diseases. High levels of ozone were found to be a precipitating factor in the damage of lung tissue elasticity and also be a factor in the rupture of blebs or bullae in occurrence of SP during spring season [17].…”

Short term association between air pollution (PM10, NO2 and O3) and secondary spontaneous pneumothorax

“…Ozone concentration increases almost linearly with the ambient temperatures and with greater intensity of sunlight, which is why O 3 concentrations are higher in warm seasons and in urban areas 29 , 31 , 32 . In the literature, Abul et al 10 showed an association between the occurrence of PSP and higher levels of O 3 in the spring. Gryparis et al 33 evaluated the relationship between acute effects of O 3 and respiratory mortality in 23 Europeans cities.…”

“…Relationships were reported between the occurrence of primary spontaneous pneumothorax (PSP) and interactions with higher values of air pollutants and other meteorological parameters, such as atmospheric pressure, temperature and humidity 6 – 9 . Abul et al 10 showed a link between an increase in O 3 and the occurrence of PSP. In a previous study, we demonstrated a lack of connection between PSP and NO 2 and PM 10 exposure, but could not rule out an association between O 3 exposure and PSP 11 .…”