Fine particulate air pollution <2.5 mm in diameter (PM2.5) is a risk factor for global morbidity and mortality, and research to identify strategies to prevent and reduce exposure among at-risk individuals is needed, according to a review paper published Dec. 7 in the Journal of the American College of Cardiology.

Jonathan D. Newman, MD, MPH, FACC, et al., summarize discussions from a May 2019 workshop, "Reducing the Cardiopulmonary Impact of Particulate Matter Air Pollution in High-Risk Populations," which was convened by the National Heart, Lung, and Blood Institute; the National Institute of Environmental Health Sciences; the U.S. Environmental Protection Agency; and the U.S. Centers for Disease Control and Prevention. During the workshop, participants discussed existing personal interventions that could be studied in clinical trials to determine their effectiveness in reducing air pollution exposures and improving cardiovascular and respiratory clinical and/or surrogate endpoints in high-risk populations.

According to the review paper, existing interventions that could be tested in a possible clinical trial include respiratory protection equipment, high-efficiency home air filtration and portable air cleaners. The workshop identified four categories for evaluation to inform an air pollution intervention trial: clinical trial design, air pollution exposure, personal interventions and determinants of adherence. In addition, the review paper outlined six domains of trial design to inform future research: population, sample size, pollution exposure levels, trial duration, potential outcomes and other design issues.

In addition, workshop participants noted that smaller-scale studies could help clarify the best approach and "address key points required to design and validate the feasibility of full-scale clinical outcome trials." Further, the review paper discusses the interactions between COVID-19 and PM2.5 exposure and how the COVID-19 pandemic could impact clinical trial design.

According to the authors, PM2.5 air pollution "poses significant threats to public health, particularly among susceptible populations, such as patients with cardiovascular and pulmonary diseases." Moving forward, strategies aimed at preventing and reducing exposure require further research, "including trials involving surrogate and hard clinical outcomes, to more precisely determine if such strategies can prevent adverse health consequences," they conclude.

Keywords: Particulate Matter, COVID-19, Public Health, Feasibility Studies, severe acute respiratory syndrome coronavirus 2, Air Pollution, Pandemics, Morbidity, Population Density

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