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Effects of various inhalation modes on the deposition of radioactive pressurized aerosols.

The deposition of aerosol consisting of Teflon particles (mass median aerodynamic diameter 3.2 micrometers) labelled with 99Tcm has been measured in patients with obstructive airways disease. Aerosol was inhaled at 30 l min-1 with 4 s breath holding (patient group A) and at 30 l min-1 with 10 s breath holding (patient group B). A further group of patients (group C) inhaled at 90 l min-1 with 10 s breath holding. Each subject was given the aerosol during inhalation at three different lung volumes (20% VC, 50% VC and 80% VC) on three different days. The greatest whole lung, tracheobronchial and alveolar depositions occurred in group B patients, irrespective of the lung volume of aerosol actuation. By comparison, deposition was similar in groups A and C only when the aerosol was actuated at 20% VC. Whole lung deposition in groups A and B was significantly correlated both with the bronchodilator response to terbutaline sulphate aerosol administered under the same inhalation conditions and with the residence time of airborne particles in the respiratory tract. The optimum inhalation technique for a beta-adrenergic aerosol indicated by these data (slow inhalation with 10 s breath holding) confirms the results of previous studies.

Aerosols↗

Effects of intravenous and aerosol nifedipine on prostaglandin F2 alpha and histamine-induced bronchoconstriction in anesthetized dogs.

The effect of nifedipine, a calcium slow channel blocking drug, was investigated by varying routes of administration in a canine model of pharmacologically induced bronchoconstriction. Control bronchopulmonary responses, i.e., increases in pulmonary resistance (RL) and decreases in dynamic lung compliance were accomplished by aerosols of prostaglandin F2 alpha and histamine in normal pentobarbital-anesthetized beagles. When infused i.v. within the range 200 to 400 micrograms/kg, nifedipine afforded significant protection vs. RL changes due to prostaglandin F2 alpha (84--89% inhibition). Aerosol pretreatment by nifedipine (0.1 and 1.0%) also produced significant inhibition in RL changes caused by prostaglandin F2 alpha. A single i.v. injection (200 micrograms/kg) of nifedipine provided significant protection against RL changes due to a histamine challenge for 240 min. The onset of protection occurred within 15 min and maximum protection occurred during the 60 to 90-min period after the single injection of nifedipine. A single aerosol pretreatment of nifedipine (0.1%) significantly blocked RL changes against successive histamine aerosol challenges at 15-, 30- and 60-min time periods. Infused nifedipine failed to have any relaxant effect on the resting base line of either RL or dynamic lung compliance, whereas aerosolized nifedipine did decrease resting airway tone intrinsically, although not significantly. In addition, cardiovascular side effects by the aerosol route were slight compared to those observed by the i.v. route of nifedipine. Therefore, delivery of a calcium channel antagonist by either the aerosol or i.v. route can inhibit pharmacologically induced bronchoconstriction.

Aerosols↗

Racemic versus l-epinephrine aerosol in the treatment of postextubation laryngeal edema: results from a prospective, randomized, double-blind study.

OBJECTIVE: To determine whether any advantage exists using racemic epinephrine instead of the more potent and less expensive levo(1)-epinephrine in the treatment of postextubation laryngeal edema. DESIGN: Prospective, double-blind, randomized study. SETTING: Pediatric intensive care unit in a university teaching hospital. PATIENTS: Twenty-eight patients with stridor during the immediate postextubation period. INTERVENTIONS: After extubation, patients demonstrating clinically important stridor were randomized in a double-blind fashion to receive an aerosol containing either 2.25% racemic or 1% l-epinephrine. MEASUREMENTS AND MAIN RESULTS: Heart rate, respiratory rate, blood pressure, and stridor score were determined at 20, 40, and 60 mins and 4 and 8 hrs after the initial aerosol administration. Patients in both groups demonstrated significant (p < .01) reductions in stridor score after aerosol administration. No significant differences were observed between treatment groups in improvement in stridor score or the number of subsequent aerosols required. Respiratory rate decreased significantly 40 and 60 mins after l-epinephrine but not after racemic epinephrine. No significant change in heart rate or blood pressure occurred after aerosol administration in either group. CONCLUSIONS: These data suggest that aerosolized l-epinephrine is as effective as aerosolized racemic epinephrine in the treatment of postextubation laryngeal edema without additional adverse side effects. When dosed appropriately, l-epinephrine is a less expensive and more widely available alternative to racemic epinephrine for the treatment of postextubation laryngeal edema.

Aerosols↗

[Ventilation aerosol therapy (author's transl)].

Ventilation aerosol therapy (a combination of intermittent positive pressure artificial respiration with aerosol therapy) produces a mechanical support for the breathing, achieves an effective aerosol action and promotes expectoration. It makes possible an effective treatment of inflammatory and obstructive bronchopulmonary diseases. The expense of apparatus and personnel for this method of treatment can only become rational and more economical for the large number of outpatients and hospitalized patients by taking advantage of a special department. The functional areas of such a ventilation aerosol department should be: outpatient department for artificial respiration, bedside artificial respiration and aerosol, ward for ventilation aerosol therapy and ventilation aerosol therapy under supervision and intensive care.

Aerosols↗

[Aerosol generation and delivery systems for pulmonary drug administration: theory and practice].

In recent years aerosol therapy has become increasingly important for the management of asthma and COPD as well as for the treatment of airway and parenchymal infections in bronchiectasis and in AIDS patients with pneumocystis carinii pneumonia. In the management of asthma inhaled steroids have become the mainstay of therapy in adults and children while bronchodilators have been relegated to a secondary role. While there has long been considerable controversy about the best way to generate and deliver aerosols, it has become evident that metered dose inhalers (MDI) and their increasingly sophisticated valved accessory devices are the most efficient, versatile and cost effective aerosol systems for the majority of patients in the adult and paediatric age group. By contrast, nebulizers are inefficient and costly and powder inhalers, while providing aerosol on inhalation, have major limitations in the paediatric age group, in less cooperative or handicapped patients and in those in emergency departments or on assisted ventilation. Recent studies have demonstrated that even in life-threatening asthma, MDI generated aerosols delivered by means of valved holding chambers are better suited to managing the acute episode because of the improved speed of administration and lower cost. Developments in aerosol therapy are likely to remain in the forefront of the management of a variety of airway and pulmonary parenchymal diseases as new and improved pharmaceutical agents and aerosol delivery systems are developed.

Administration, Inhalation↗

Preliminary study of the efficacy of insulin aerosol delivered by oral inhalation in diabetic patients.

OBJECTIVE: To maximize deposition of an aerosolized dose of insulin (mean +/- SD = 0.99 +/- 0.06 U/kg of body weight) in the lungs of subjects with non-insulin-dependent diabetes mellitus (NIDDM), and investigate its efficacy in normalizing plasma glucose levels during the fasting state. DESIGN: Nonrandomized, placebo-controlled trial. SETTING: A primary care facility. PATIENTS OR OTHER PARTICIPANTS: Six nonobese, nonsmoking volunteers with NIDDM. No subjects withdrew from the study. INTERVENTION: Aerosolized insulin was administered by oral inhalation after a 12-hour period of fasting. Aerosol was generated by a raindrop nebulizer from regular 500 U/mL pork insulin. During inhalation, inspiratory flow was regulated at 17 L/min. Plasma samples were collected after inhalation and analyzed for insulin and glucose levels. MAIN OUTCOME MEASURES: Plasma insulin and glucose levels. RESULTS: Deposition of the aerosol was maximized within the lungs, with 79% +/- 17% of the inhaled dose depositing below the larynx. Geometric mean fasting plasma insulin level was 71 pmol/L (11.8 microU/mL), rising to 269 pmol/L (44.8 microU/mL) after insulin inhalation. Average time to peak insulin level was 40 +/- 34 minutes. The mean fasting plasma glucose level (12.63 +/- 2.59 mmol/L [225.5 +/- 46.3 mg/dL]) was reduced to within the normal range in five subjects and was almost normal in the sixth subject (5.52 +/- 0.89 mmol/L [98.6 +/- 15.9 mg/dL]). Average maximum decrease in plasma glucose from baseline was 55% +/- 10% (n = 6) vs 13% +/- 9% after placebo aerosol inhalation (n = 3). No side effects were reported following insulin or placebo aerosol inhalation. CONCLUSIONS: These preliminary results indicate that a dose of approximately 1.0 U of aerosolized insulin per kilogram of body weight, delivered by oral inhalation and deposited predominantly within the lungs, is well tolerated and can effectively normalize plasma glucose levels in patients with NIDDM.

Administration, Inhalation↗

Lack of effect of prophylactic aerosolized pentamidine on the detection of Pneumocystis carinii in induced sputum or bronchoalveolar lavage specimens.

Two independent studies were undertaken to determine the effect of prophylactic treatment with aerosolized pentamidine on the laboratory diagnosis of Pneumocystis carinii pneumonia in individuals at risk for or with the acquired immunodeficiency syndrome. The first study was a retrospective analysis to determine the effect of prophylactic treatment with aerosolized pentamidine on the diagnostic yield and sensitivity of detection of P carinii in induced sputum specimens. The results of examinations of 110 induced sputum specimens from patients who had not received aerosolized pentamidine were compared with the findings in 57 specimens from patients who had. There was no statistically significant difference between the two groups for the diagnostic yield in induced sputum specimens (48% vs 47%) or in bronchoalveolar lavage fluid specimens subsequently obtained from patients with nondiagnostic induced sputum examinations (33% vs 37%). The sensitivity of induced sputum specimens for identifying P carinii was 76% to 78% for patients who had not received aerosolized pentamidine and 71% to 75% for patients who had received the drug. The second study was a prospective comparison of 118 bronchoalveolar lavage fluid specimens to determine the effect of prophylactic treatment with aerosolized pentamidine on the number of organisms present. One hundred eighteen bronchoalveolar lavage fluid specimens were quantitatively examined and scored according to the number of clumps of P carinii present. No statistically significant difference was seen in the number of clumps of P carinii found in specimens from patients who had received aerosolized pentamidine vs the number of clumps found in specimens from patients who had not. In conclusion, prophylactic treatment with aerosolized pentamidine had no effect on (1) the diagnostic yield and sensitivity of detection of P carinii in induced sputum specimens or (2) the number of organisms detected in bronchoalveolar lavage fluid specimens obtained from individuals at risk for or with the acquired immunodeficiency syndrome.

AIDS-Related Opportunistic Infections↗

Strategies for the prevention of a successful biological warfare aerosol attack.

Biological warfare (BW) aerosol attacks are different from chemical attacks in that they may provide no warning/all clear signals that allow the soldier to put on or remove his M17/M40 protective mask. Methods are now being perfected to detect a BW aerosol cloud using an airborne (helicopter) pulsed laser system to scan the lower altitudes upwind from a troop concentration of corps size, and to sample and analyze the nature of the aerosol within a brief time interval. This system has certain limitations and vulnerabilities, since it is designed specifically to detect a line-type aerosol attack. Provision of, training with, and field use of a lightweight dust mist or HEPA filter respirator for each soldier is proposed for protection against undetected aerosol attacks. This particulate filter respirator would be issued in addition to the M17/M40 mask. Such a BW respirator will be able to purify the soldier's air by removing particles in the 0.3- to 15-micro m-diameter range with an efficiency of 98 to 100%. Particle size of BW aerosols is in the same range, with an optimum size for high-efficiency casualty production of 1 to 5 micro m mass median diameter. The proposed BW respirator will be lightweight; will require low inhalation pressures; will be comfortable to wear for prolonged periods; will not interfere with vision, hearing, and communication; and will not degrade overall effectiveness and performance to the degree observed with the M17/M40 masks. Such respirators would be worn as part of a contingency defense against an enemy likely to use BW agents. This respirator could be worn for prolonged periods when under threat of an undetectable BW attack during weather conditions favorable to the success of such an attack (i.e., low wind velocity and temperature inversion in the target area). In addition, tactically important assets such as command and control centers and missile batteries can also be protected continuously by air filtration systems powered by electricity (modular collective protection equipment). Vaccinations against anthrax, botulism, Q fever, plague, and tularemia are now available and immune protection against ricin and staphylococcal toxins appears feasible in the near future. Chemotherapy can also be provided for prophylaxis of infectious agents released on the battlefield. The vaccines and antibiotics can provide back-up protection against an unexpected BW attack during a period when the BW respirator is not in use or malfunctions due to a poor seal or filter leak. Enemy sites of biological weapon production, assembly, testing, and storage, and delivery vehicles can be targeted for destruction by bombs and/or missiles. An integrated, well-planned, BW defense with multiple components can decrease the likelihood of a successful enemy BW aerosol attack.

Aerosols↗

Experiments with a model of aerosol immunization of mice and swine against Erysipelothrix insidiosa (E. i.).

Whole antigens as well as antigen fractions from E.i. were tested as aerosol vaccines. The aerosol produced by a jet nebulizer (Pari, Standard 088) with a capacity of 15 1 air per min and about 10g vaccine per hour was tested by size measuring of the aerosol particles and bacteriological evidence of E.i. in lung tissue. The main concern of the studies was to test the immunogenicity for laboratory animals which were exposed to the vaccines in a modified Henderson apparatus or in boxes of 30 1 respectively. Vaccination trials with conventional mice and piglets did not produce 100% protection against challenge infection by aerosol or subcutaneous route. Experiments with gnotobiotic piglets resulted in sufficient immunity against aerosol challenge with 100 LD50 when aerosols with living avirulent bacteria (strain B 10) were applied three times for one hour or once during three hours. A commercial vaccine from lyzed bacteria immunized only when aerosols were applied three times for three hours. For further immunological evaluation the sera of piglets were tested by means of an indirect fluorescent technique and by other serological methods.

Aerosols↗

[Aerosol therapy].

Aerosol therapy plays a major role in the diagnosis and treatment of various lung diseases. The aim of inhalation therapy is to deposit a reproducible and adequate dose of a specific drug to the airways, in order to achieve a high, local, clinical effect while avoiding serious systemic side effects. To achieve this goal, it is therefore important to have an efficient inhalation device to deliver different medications. However, the currently available therapeutic inhalation devices (nebuliser, pressurised metered-dose inhaler and dry powder inhaler) are not very efficient in aerosol delivery and have several disadvantages. Inhalation devices can be assessed by in vitro studies, filter studies and radiolabelled deposition studies. Several radiolabelled deposition studies have shown that nebulisers and pressurised metered-dose inhalers are not very efficient in aerosol delivery. In children, before 1997, only 0.5% to 15% of the total nebulised or actuated dose from a nebuliser or pressurised metered-dose inhaler actually reached the lungs. These numbers were somewhat improved in adults, 30% of the total nebulised or actuated dose reaching the airways. Aerosol therapy with dry powder inhalers was the most efficient before 1997, 30% of the total dose being deposited in the lungs of adults and children. In 1997, new developments in pressurised metered-dose inhalers much improved their efficiency in aerosol delivery. Lung deposition can be increased by up to 60% with use of a non-electrostatic holding chamber and/or a pressurised metered-dose inhaler with a hydrofluoroalkane propellant possessing superior aerosol characteristics. Several studies comparing the clinical efficiency of different inhalation devices have shown that the choice of an optimal inhalation device is crucial. In addition to the aerosol characteristics, ventilation parameters and airway morphology have an important bearing on deposition patterns. These parameters may be greatly influenced by the patient's acceptance of a specific inhalation device and therefore determine the choice of the device used. It is important for the clinical impact to develop more efficient inhalation devices, which need to be assessed for use in different age groups. These devices should be cheap, easy to use, portable, usable with all medications and environmentally safe.

Adult↗

[Size distribution of artificial and natural radioactive aerosols in the 30-kilometer zone of the Chernobyl AES in 1986-1996].

During 10 years after the Chernobyl accident the systematical measurings of size distributions of radioactive aerosols were conducted near the block-IV. In the ground level the active median aerodynamic diameters (AMAD) of 137Cs aerosols were ranged from 0.4 up to 1.4 microns in May, 1986. In that time the aerosol carriers of radioactive Te, Ru and I had AMAD 0.3 ... 0.5 micron. During 1987-1996 AMAD of aerosol of fission products of the Chernobyl accident was stable in range 4 ... 7 microns. Simultaneously concentrations and size distributions of natural radioactive aerosols were determined. The cosmogenic 7Be aerosols had AMAD 0.5 ... 0.7 micron. AMAD of the aerosols of daughter products of radon and thoron was found 0.4 ... 0.6 micron.

Aerosols↗

Reversal of bronchial obstruction in children with mild stable asthma by aerosolized furosemide.

Aerosolized furosemide has been shown to prevent the worsening of different variables in pulmonary function testing, following exercise or bronchial provocation with numerous agents. To investigate if aerosolized furosemide has a bronchodilator effect, we performed two prospective, randomized, placebo-controlled, double-blinded and crossover studies of four aerosol regimens in children with mild chronic asthma. In a pilot study examining three different doses of furosemide in 11 children, the dose of 1.0 mg/kg resulted in a mean maximum increase of 30.0 +/- 6.8% in forced expiratory flow between 25 and 75% vital capacity (FEF25-75), compared with a 3.1 +/- 6.8% increase after aerosolized normal saline. The effect was observed after 10 minutes with a mean percent change of 17.7 +/- 1.7% from baseline, that persisted to 30 minutes (19.3 +/- 3.7%) and was significantly greater than that seen following aerosolized placebo (1.4 +/- 2.9% and 0.7 +/- 3.4%, respectively; P < 0.05). We then compared the effect of furosemide with that of aerosolized albuterol (0.15 mg/kg) in 18 patients. There was no statistically significant difference in the improvement observed in forced expiratory volume in 1 second (FEV1) for albuterol (15.0 +/- 2.7%) compared with furosemide (12.1 +/- 2.9%) or in FEF25-75 (42.9 +/- 9.0% versus 26.3 +/- 6.7%). The addition of albuterol to furosemide resulted in a 17.2 +/- 5.9% increase in FEV1 and a 51.1 +/- 13.9% increase in FEF25-75. Our results indicate that aerosolized furosemide has a bronchodilator effect in children with mild stable asthma.

Administration, Inhalation↗

Transgene expression in mouse airway epithelium by aerosol gene therapy with PEI-DNA complexes.

Gene therapy targeted at the respiratory epithelium holds therapeutic potential for diseases such as cystic fibrosis and alpha-1 anti-trypsin deficiency. A variety of approaches such as intranasal or intratracheal instillation and aerosol delivery have been utilized to target genes to the airways. Polyethylenimine (PEI), a linear or branched polycationic polymer, has been used for delivery of genes to various organs. In this study, using fluorescein isothiocyanate (FITC)-labeled branched PEI, we initially examined the localization of PEI in the lungs after aerosol delivery to Balb/C mice. Further, after aerosol delivery of PEI-CAT DNA, in situ immunostaining for chloramphenicol acetyl transferase (CAT) protein was used to localize the transgene expression within the lungs. Immunohistochemistry for CAT, as well as localization of FITC-labeled PEI, revealed that after aerosol delivery, the PEI-DNA complexes deposit and subsequently transfect most of the epithelial cells in the conducting airways (including the peripheral airways). High levels of CAT were detected at 24 h after aerosol exposure and significant CAT expression was detected in the lungs up to 28 days after a single aerosol exposure. The data suggest that aerosol delivery of PEI-DNA complexes could be effective for the treatment of pulmonary diseases such as cystic fibrosis and alpha-1 anti-trypsin deficiency.

Administration, Inhalation↗

Role of radio-aerosol and perfusion lung imaging in early detection of chronic obstructive lung disease.

The efficacy of radio-aerosol and perfusion lung imaging in the early detection of chronic obstructive lung disease was evaluated in 38 subjects. The subjects included 5 non-smokers, 21 smokers with minimal or no respiratory symptoms and 12 patients with chronic obstructive lung disease. Each subject consented to a respiratory questionnaire, detailed physical examination, chest X-ray examinations, detailed pulmonary function tests and 99mTc-radio aerosol-inhalation lung imaging. Perfusion lung imaging with 99mTc-labelled macroaggregated albumin was performed in 22 subjects. A significant correlation (P less than 0.001) was observed between the degree of abnormalities on radio-aerosol imaging and pulmonary function tests (PFTs) including forced expiratory volume in 1 s, maximum mid-expiratory flow rate and mean transit time analysis. Abnormal radio-aerosol patterns and deranged PFTs were observed in 21 subjects each. Of 21 subjects with abnormal radioaerosol pattern 8 had normal PFTs. Of 21 subjects with abnormal PFTs 8 had normal aerosol images. Aerosol lung images and PFTs were abnormal more frequently than perfusion lung images. The results suggest that radio-aerosol lung imaging is as sensitive an indicator as PFTs for early detection of chronic obstructive lung disease and can be usefully combined with PFTs for early detection of alteration in pulmonary physiology in smokers.

Adolescent↗

Studies on the survival of aerosolized bovine rotavirus (UK) and a murine rotavirus.

The effect of relative humidity (RH) and temperature on the survival of airborne bovine rotavirus UK isolate (BRV-UK) and a murine rotavirus (MRV) was studied. In any one experiment, the virus under test was suspended in tryptose phosphate broth (TPB) supplemented with uranine (physical tracer) and an antifoam, was aerosolized using a Collison nebulizer into the rotating drum with the RH at either low (30 +/- 5%), medium (50 + 5%) or high (80 +/- 5%) level at 20 +/- 1 degrees C. Following a 15-min period of viral aerosol stabilization, sequential samples of drum air were collected using an All-Glass Impinger (AGI) for 24 h post-aerosolization. Both of the rotavirus isolates were found to survive best at medium RH level and high RH was found least favorable for the survival of these aerosolized rotaviruses. The survival pattern of aerosolized MRV was found to be the best when compared with survival pattern of all animal and human rotavirus isolates studies performed under aerosolized conditions in our laboratory. The findings of these experiments confirm and extend our previous reports on the survival of other animal and human aerosolized rotaviruses and emphasize the fact that air may be one of the vehicles for their dissemination and could explain why it is difficult to control nosocomial outbreaks of rotavirus gastroenteritis and to keep animal colonies rotavirus-free.

Air Microbiology↗

Tobramycin Serum Concentrations After Aerosol and Oral Administration in Cystic Fibrosis.

We sought to describe tobramycin absorption after aerosol administration to cystic fibrosis (CF) subjects. Serum tobramycin concentrations were determined by modification of the radioimmuno-assay (RIA) technique, lowering the limit of detection from 1.0 &mgr;g ml(minus sign1) to 0.05 &mgr;g ml(minus sign1). In 37 studies, after aerosol delivery of 666 plus minus 195 mg to the airway of 24 patients, in which 222 samples were assayed, only 1 serum sample contained tobramycin at a concentration greater than 1.0 &mgr;g ml(minus sign1). Twenty-six of the 37 studies permitted estimation of pharmacokinetic parameters of tobramycin. The serum clearance of tobramycin following aerosol adminstration is 39.13 plus minus 0.393 L h(minus sign1) (mean plus minus standard error of the mean), with an elimination half-life of 3.072 plus minus 0.194 h. The half-life was significantly longer than that found after intravenous adminstration. The elimination rate constant (K(e)) was calculated to be 0.234 plus minus 0.002 h(minus sign1). Estimated total-body clearance in which systemic absorption was determined from sputum and urinary recovery of tobramycin was 0.094 plus minus 0.002 1 hr(minus sign1) kg(minus sign1). We also studied tobramycin absorption in six CF subjects after ingestion of a 80-mg m(minus sign2) dose, to gain insight into the tobramycin levels observed after swallowing an aerosol. Four out of the six subjects had measurable serum tobramycin concentration after ingestion. The serum concentration-time curve mirrored what was seen after aerosol administration. We concluded that tobramycin has poor systemic absorption in CF subjects after aerosol administration. Tobramycin in serum after aerosol administration is in part due to the gastrointestinal absorption of swallowed drug, as well as absorption from lower respiratory tract.

Journal Article↗

Aerosol effect on cloud droplet size monitored from satellite.

Aerosol concentration and cloud droplet radii derived from space-borne measurements are used to explore the effect of aerosols on cloud microphysics. Cloud droplet size is found to be largest (14 micrometers) over remote tropical oceans and smallest (6 micrometers) over highly polluted continental areas. Small droplets are also present in clouds downwind of continents. By using estimates of droplet radii coupled with aerosol load, a statistical mean relationship is derived. The cloud droplet size appears to be better correlated with an aerosol index that is representative of the aerosol column number under some assumptions than with the aerosol optical thickness. This study reveals that the effect of aerosols on cloud microphysics is significant and occurs on a global scale.

Journal Article↗

Smoke and pollution aerosol effect on cloud cover.

Pollution and smoke aerosols can increase or decrease the cloud cover. This duality in the effects of aerosols forms one of the largest uncertainties in climate research. Using solar measurements from Aerosol Robotic Network sites around the globe, we show an increase in cloud cover with an increase in the aerosol column concentration and an inverse dependence on the aerosol absorption of sunlight. The emerging rule appears to be independent of geographical location or aerosol type, thus increasing our confidence in the understanding of these aerosol effects on the clouds and climate. Preliminary estimates suggest an increase of 5% in cloud cover.

Journal Article↗