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Carr JA, Barau AS, Jew EKK, Kirshner JD, Marchant RA, Salisu AT, Petrokofsky G, Tomei J, Stringer LC. A methodological framework for assessing development solutions: application to wood fuel challenges in Nigeria. Sci Rep 2025; 15:13072. [PMID: 40240523 PMCID: PMC12003808 DOI: 10.1038/s41598-025-97815-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2024] [Accepted: 04/07/2025] [Indexed: 04/18/2025] Open
Abstract
Development interventions often yield co-benefits and trade-offs across multiple Sustainable Development Goals (SDGs). However, current approaches typically assess progress towards specific SDG targets, such as increasing access to clean energy or improving health outcomes, rather than evaluating the co-benefits and trade-offs of the solutions used to achieve these targets. This study introduces a solutions-oriented methodology to assess the impacts of development solutions, applied to the case of wood fuel cooking-related challenges in Nigeria. Using a rapid evidence assessment and stakeholder workshop, we identify co-benefits, trade-offs, and barriers associated with 13 wood fuel-related solutions, classified into three types: enhancing fuelwood availability, adopting alternative technologies, and implementing external interventions. We find solutions that increase wood fuel availability can address environmental and social issues, but not health challenges, while alternative fuels/technologies face affordability, market, and cultural acceptance barriers. We highlight data limitations and propose an iterative process to comprehensively evaluate solutions' impacts. This process facilitates context-specific, cross-sectoral planning but underscores that no universal solution exists. Successful interventions require multi-sector collaboration, public education, and strengthened governance to balance competing priorities and ensure equitable outcomes. By advancing solutions-based approaches, this study contributes to integrating SDG interactions into practical, evidence-informed policy and programming.
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Affiliation(s)
- Jamie A Carr
- Leverhulme Centre for Anthropocene Biodiversity, University of York, York, UK.
- Department of Environment and Geography, University of York, York, UK.
- York Environmental Sustainability Institute, University of York, York, UK.
| | - Aliyu Salisu Barau
- Department of Urban and Regional Planning, Faculty of Earth and Environmental Sciences, Bayero University Kano, Kano, Nigeria
| | - Eleanor K K Jew
- Department of Environment and Geography, University of York, York, UK
- Interdisciplinary Global Development Centre, University of York, York, UK
| | - Joshua D Kirshner
- Department of Environment and Geography, University of York, York, UK
- Interdisciplinary Global Development Centre, University of York, York, UK
| | - Robert A Marchant
- Department of Environment and Geography, University of York, York, UK
- York Environmental Sustainability Institute, University of York, York, UK
| | - Abubakar Tanimu Salisu
- Department of Urban and Regional Planning, Faculty of Earth and Environmental Sciences, Bayero University Kano, Kano, Nigeria
| | - Gillian Petrokofsky
- Oxford Systematic Reviews, 266 Banbury Road, Oxford, UK
- Oxford Long-term Ecology Lab, Department of Biology, University of Oxford, South Parks Road, Oxford, UK
| | - Julia Tomei
- UCL Institute for Sustainable Resources, University College London, London, UK
| | - Lindsay C Stringer
- Leverhulme Centre for Anthropocene Biodiversity, University of York, York, UK
- Department of Environment and Geography, University of York, York, UK
- York Environmental Sustainability Institute, University of York, York, UK
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Jafta N, Shezi B, Buthelezi M, Muteti-Fana S, Naidoo RN. Household air pollution and respiratory health in Africa: persistent risk and unchanged health burdens. Curr Opin Pulm Med 2025; 31:89-97. [PMID: 39410863 PMCID: PMC11789611 DOI: 10.1097/mcp.0000000000001126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2024]
Abstract
PURPOSE OF REVIEW Despite evidence emerging from the Global Burden of Disease studies that biomass use and household air pollution are declining globally, with important positive health impacts for households in low- and middle-income countries, these trends have not been equally documented in African countries. This review describes the state of household air pollution exposure and its relationship with respiratory disease in Africa. RECENT FINDINGS African studies on this topic are limited, and generally focus on respiratory infections. Most evidence emerge from models based on the Global Burden of Disease data, and from limited individual epidemiological studies across the continent. More than 80% of the African population is exposed to household air pollution. Women and children continue to bear the substantial burden of exposure. Evidence from limited exposure-response studies strongly points to household air pollution being the major driver of acute and chronic respiratory diseases on the continent. SUMMARY Respiratory infections, particularly in children, and other chronic respiratory diseases, are strongly attributable to household air pollution. Elimination of such exposures through interventions such as cleaner fuels and preferably, electricity, is critical to improving respiratory health on the continent.
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Affiliation(s)
- Nkosana Jafta
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, University of KwaZulu-Natal
| | - Busisiwe Shezi
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, University of KwaZulu-Natal
- Environment and Health Research Unit, South African Medical Research Council, Durban, South Africa
| | - Minenhle Buthelezi
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, University of KwaZulu-Natal
| | - Shamiso Muteti-Fana
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, University of KwaZulu-Natal
- Department of Global, Public Health and Family Medicine, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Rajen N. Naidoo
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, University of KwaZulu-Natal
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Jardel H, Rappazzo KM, Luben TJ, Keeler C, Staley BS, Ward-Caviness CK, O’Lenick CR, Rebuli ME, Xi Y, Hernandez M, Chelminski A, Jaspers I, Rappold AG, Dhingra R. Gestational and postnatal exposure to wildfire smoke and prolonged use of respiratory medications in early life. ENVIRONMENTAL RESEARCH, HEALTH : ERH 2024; 2:045004. [PMID: 39268508 PMCID: PMC11389793 DOI: 10.1088/2752-5309/ad748c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/30/2024] [Accepted: 08/28/2024] [Indexed: 09/15/2024]
Abstract
As wildfire frequency and severity increases, smoke exposures will cause increasingly more adverse respiratory effects. While acute respiratory effects of smoke exposure have been documented in children, longer term sequelae are largely unstudied. Our objective here was to examine the association between gestational and postnatal exposure to wildfire smoke and prolonged use of prescription medication for respiratory conditions in early childhood. Using Merative MarketScan claims data, we created cohorts of term children born in western states between 1 January 2010-31 December 2014 followed for at least three years. Using NOAA Hazard Mapping System data, we determined the average number of days a week that >25% of the population in a metropolitan statistical area (MSA) was covered by smoke within each exposure period. The exposure periods were defined by trimester and two 12 week postnatal periods. Medication use was based on respiratory indication (upper respiratory, lower respiratory, or any respiratory condition) and categorized into outcomes of prolonged use (⩾30 d use) (PU) and multiple prolonged uses (at least two prolonged uses) (MPU). We used logistic regression models with random intercepts for MSAs adjusted for child sex, birth season, and birth year. Associations differed by exposure period and respiratory outcome, with elevated risk of MPU of lower respiratory medications following exposure in the third trimester and the first 12 postnatal weeks (RR 1.15, 95% CI 0.98, 1.35; RR 1.21, 95% CI 1.05, 1.40, respectively). Exposure in the third trimester was associated with an increase in MPU of any respiratory among males infants only (male RR 1.22, 95% CI 1.00, 1.50; female RR 0.93, 95% CI 0.66, 1.31). Through novel use of prescription claims data, this work identifies critical developmental windows in the 3rd trimester and first 12 postnatal weeks during which environmental inhalational disaster events may impact longer-term respiratory health.
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Affiliation(s)
- Hanna Jardel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, United States of America
- Oak Ridge Institute for Science and Education (ORISE) Predoctoral Fellow at United States Environmental Protection Agency (US EPA), Research Triangle Park, NC, United States of America
| | - Kristen M Rappazzo
- U.S. Environmental Protection Agency, Office of Research and Development, Center for Public Health and Environmental Assessment, Research Triangle Park, NC, United States of America
| | - Thomas J Luben
- U.S. Environmental Protection Agency, Office of Research and Development, Center for Public Health and Environmental Assessment, Research Triangle Park, NC, United States of America
| | - Corinna Keeler
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, United States of America
- U.S. Environmental Protection Agency, Office of Research and Development, Center for Public Health and Environmental Assessment, Research Triangle Park, NC, United States of America
| | - Brooke S Staley
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, United States of America
| | - Cavin K Ward-Caviness
- U.S. Environmental Protection Agency, Office of Research and Development, Center for Public Health and Environmental Assessment, Research Triangle Park, NC, United States of America
| | - Cassandra R O’Lenick
- Center for Environmental Medicine, Asthma, and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Meghan E Rebuli
- Center for Environmental Medicine, Asthma, and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Yuzhi Xi
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, United States of America
- Oak Ridge Institute for Science and Education (ORISE) Predoctoral Fellow at United States Environmental Protection Agency (US EPA), Research Triangle Park, NC, United States of America
| | - Michelle Hernandez
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Ann Chelminski
- U.S. Environmental Protection Agency, Office of Research and Development, Center for Public Health and Environmental Assessment, Research Triangle Park, NC, United States of America
| | - Ilona Jaspers
- Center for Environmental Medicine, Asthma, and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Ana G Rappold
- U.S. Environmental Protection Agency, Office of Research and Development, Center for Public Health and Environmental Assessment, Research Triangle Park, NC, United States of America
| | - Radhika Dhingra
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Brody School of Medicine, East Carolina University, Greenville, NC, United States of America
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许 婷, 冯 雍, 尚 云. [Application of interrupter resistance pulmonary function testing in the diagnosis of asthma in preschool children: a single-center study]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2024; 26:1187-1193. [PMID: 39587748 PMCID: PMC11601106 DOI: 10.7499/j.issn.1008-8830.2407042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 10/15/2024] [Indexed: 11/27/2024]
Abstract
OBJECTIVES To investigate the value of interrupter resistance (Rint) pulmonary function testing in the diagnosis of asthma in preschool children, and to compare the significance of Rint pulmonary function testing versus impulse oscillometry (IOS) in the diagnosis of asthma. METHODS A prospective study was conducted among 108 children with recurrent wheezing, aged 4 to <6 years, who were admitted from July 2022 to November 2023. According to the treatment outcome, they were divided into an asthmatic group (61 children) and a non-asthmatic group (47 children). Rint pulmonary function parameters and IOS parameters were analyzed for both groups, and the two tests were compared in terms of feasibility and diagnostic value. RESULTS Compared with the non-asthmatic group, the asthmatic group had significantly higher percentage of actual measured value to predicted value for Rint and percent changes in the measured value and predicted value of Rint (P<0.05). The receiver operating characteristic curve analysis showed that the percent change in the predicted value of Rint had an optimal cut-off value of 32.0% in the diagnosis of asthma in preschool children, with an area under the curve (AUC) of 0.705, a sensitivity of 41.0%, and a specificity of 91.5% (P<0.05). In terms of the degree of completion, 18 children (16.7%) failed to complete the IOS test, but they could successfully complete Rint pulmonary function testing with good quality control. Rint pulmonary function testing and IOS had a similar area under the curve in the diagnosis of asthma in preschool children (P>0.05). CONCLUSIONS Rint pulmonary function testing can be used to assist in the diagnosis of asthma in preschool children, with a similar diagnostic value to IOS and a relatively high level of feasibility. A percent change of ≥32% in the predicted value of Rint in the bronchial dilation test can be used as a cut-off value for the diagnosis of asthma in preschool children.
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Wallbanks S, Griffiths B, Thomas M, Price OJ, Sylvester KP. Impact of environmental air pollution on respiratory health and function. Physiol Rep 2024; 12:e70006. [PMID: 39175108 PMCID: PMC11341277 DOI: 10.14814/phy2.70006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 07/30/2024] [Accepted: 08/06/2024] [Indexed: 08/24/2024] Open
Abstract
Environmental air pollution presents a considerable risk to global respiratory health. If critical levels are exceeded, inhaled pollutants can lead to the development of respiratory dysfunction and provoke exacerbation in those with pre-existing chronic respiratory disease. Over 90% of the global population currently reside in areas where environmental air pollution is considered excessive-with adverse effects ranging from acute airway irritation to complex immunomodulatory alterations. This narrative review provides an up-to-date perspective concerning the impact of environmental air pollution on respiratory health and function and describes the underpinning mechanisms that contribute to the development and progression of chronic respiratory disease.
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Affiliation(s)
- Samuel Wallbanks
- Birmingham Heartlands HospitalUniversity Hospitals BirminghamBirminghamUK
| | - Benjamin Griffiths
- School of Biomedical Sciences, Faculty of Biological SciencesUniversity of LeedsLeedsUK
| | - Maximillian Thomas
- Respiratory PhysiologyUniversity Hospitals Sussex NHS Foundation TrustBrightonUK
| | - Oliver J. Price
- School of Biomedical Sciences, Faculty of Biological SciencesUniversity of LeedsLeedsUK
- Department of Respiratory MedicineLeeds Teaching Hospitals NHS TrustLeedsUK
| | - Karl P. Sylvester
- Respiratory PhysiologyPapworth Hospital NHS Foundation TrustCambridgeUK
- Respiratory PhysiologyCambridge University Hospitals NHS Foundation TrustCambridgeUK
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McCollum ED, Checkley W, Balakrishnan K, Clasen TF, Peel JL. Fetal and Early-Life Stove and Fuel Interventions and Respiratory Oscillometry Lung Function Measures in Preschool-Aged Children from Ghana. Am J Respir Crit Care Med 2024; 209:625-626. [PMID: 38290112 PMCID: PMC10945070 DOI: 10.1164/rccm.202311-2197ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/30/2024] [Indexed: 02/01/2024] Open
Affiliation(s)
- Eric D McCollum
- School of Medicine
- Bloomberg School of Public Health Johns Hopkins University Baltimore, Maryland
| | - William Checkley
- School of Medicine
- Bloomberg School of Public Health Johns Hopkins University Baltimore, Maryland
| | - Kalpana Balakrishnan
- Department of Environmental Health Engineering Sri Ramachandra Institute for Higher Education and Research Chennai, India
| | - Thomas F Clasen
- Rollins School of Public Health Emory University Atlanta, Georgia
| | - Jennifer L Peel
- Department of Environmental and Radiological Health Sciences Colorado State University Fort Collins, Colorado
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Agyapong PD, Jack D, Kaali S, Colicino E, Mujtaba MN, Chillrud SN, Osei M, Gennings C, Agyei O, Kinney PL, Kwarteng A, Perzanowski M, Dwommoh Prah RK, Tawiah T, Asante KP, Lee AG. Household Air Pollution and Child Lung Function: The Ghana Randomized Air Pollution and Health Study. Am J Respir Crit Care Med 2024; 209:716-726. [PMID: 38016085 PMCID: PMC12039047 DOI: 10.1164/rccm.202303-0623oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 11/28/2023] [Indexed: 11/30/2023] Open
Abstract
Rationale: The impact of a household air pollution (HAP) stove intervention on child lung function has been poorly described. Objectives: To assess the effect of a HAP stove intervention for infants prenatally to age 1 on, and exposure-response associations with, lung function at child age 4. Methods: The Ghana Randomized Air Pollution and Health Study randomized pregnant women to liquefied petroleum gas (LPG), improved biomass, or open-fire (control) stove conditions through child age 1. We quantified HAP exposure by repeated maternal and child personal carbon monoxide (CO) exposure measurements. Children performed oscillometry, an effort-independent lung function measurement, at age 4. We examined associations between Ghana Randomized Air Pollution and Health Study stove assignment and prenatal and infant CO measurements and oscillometry using generalized linear regression models. We used reverse distributed lag models to examine time-varying associations between prenatal CO and oscillometry. Measurements and Main Results: The primary oscillometry measure was reactance at 5 Hz, X5, a measure of elastic and inertial lung properties. Secondary measures included total, large airway, and small airway resistance at 5 Hz, 20 Hz, and the difference in resistance at 5 Hz and 20 Hz (R5, R20, and R5-20, respectively); area of reactance (AX); and resonant frequency. Of the 683 children who attended the lung function visit, 567 (83%) performed acceptable oscillometry. A total of 221, 106, and 240 children were from the LPG, improved biomass, and control arms, respectively. Compared with control, the improved biomass stove condition was associated with lower reactance at 5 Hz (X5 z-score: β = -0.25; 95% confidence interval [CI] = -0.39, -0.11), higher large airway resistance (R20 z-score: β = 0.34; 95% CI = 0.23, 0.44), and higher AX (AX z-score: β = 0.16; 95% CI = 0.06, 0.26), which is suggestive of overall worse lung function. The LPG stove condition was associated with higher X5 (X5 score: β = 0.16; 95% CI = 0.01, 0.31) and lower small airway resistance (R5-20 z-score: β = -0.15; 95% CI = -0.30, 0.0), which is suggestive of better small airway function. Higher average prenatal CO exposure was associated with higher R5 and R20, and distributed lag models identified sensitive windows of exposure between CO and X5, R5, R20, and R5-20. Conclusions: These data support the importance of prenatal HAP exposure on child lung function. Clinical trial registered with www.clinicaltrials.gov (NCT01335490).
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Affiliation(s)
- Prince Darko Agyapong
- Kintampo Health Research Centre, Research and Development, Division Ghana Health Service, Bono East Region Kintampo North, Ghana
| | - Darby Jack
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Seyram Kaali
- Kintampo Health Research Centre, Research and Development, Division Ghana Health Service, Bono East Region Kintampo North, Ghana
| | | | - Mohammed Nuhu Mujtaba
- Kintampo Health Research Centre, Research and Development, Division Ghana Health Service, Bono East Region Kintampo North, Ghana
| | - Steven N Chillrud
- Lamont-Doherty Earth Observatory at Columbia University, Palisades, New York; and
| | - Musah Osei
- Kintampo Health Research Centre, Research and Development, Division Ghana Health Service, Bono East Region Kintampo North, Ghana
| | - Chris Gennings
- Department of Environmental Medicine and Public Health
- Institute for Exposomic Research, and
| | - Oscar Agyei
- Kintampo Health Research Centre, Research and Development, Division Ghana Health Service, Bono East Region Kintampo North, Ghana
| | - Patrick L Kinney
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | - Adolphine Kwarteng
- Kintampo Health Research Centre, Research and Development, Division Ghana Health Service, Bono East Region Kintampo North, Ghana
| | - Matthew Perzanowski
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Rebecca Kyerewaa Dwommoh Prah
- Kintampo Health Research Centre, Research and Development, Division Ghana Health Service, Bono East Region Kintampo North, Ghana
| | - Theresa Tawiah
- Kintampo Health Research Centre, Research and Development, Division Ghana Health Service, Bono East Region Kintampo North, Ghana
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Research and Development, Division Ghana Health Service, Bono East Region Kintampo North, Ghana
| | - Alison G Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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Chaya S, Vanker A, Brittain K, MacGinty R, Jacobs C, Hantos Z, Zar HJ, Gray DM. The impact of antenatal and postnatal indoor air pollution or tobacco smoke exposure on lung function at 3 years in an African birth cohort. Respirology 2023; 28:1154-1165. [PMID: 37587874 PMCID: PMC10947154 DOI: 10.1111/resp.14576] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 08/02/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND AND OBJECTIVE Indoor air pollution (IAP) and tobacco smoke exposure (ETS) are global health concerns contributing to the burden of childhood respiratory disease. Studies assessing the effects of IAP and ETS in preschool children are limited. We assessed the impact of antenatal and postnatal IAP and ETS exposure on lung function in a South African birth cohort, the Drakenstein Child Health Study. METHODS Antenatally enrolled mother-child pairs were followed from birth. Lung function measurements (oscillometry, multiple breath washout and tidal breathing) were performed at 6 weeks and 3 years. Quantitative antenatal and postnatal IAP (particulate matter [PM10 ], volatile organic compounds [VOC]) and ETS exposures were measured. Linear regression models explored the effects of antenatal and postnatal exposures on lung function at 3 years. RESULTS Five hundred eighty-four children had successful lung function testing, mean (SD) age of 37.3 (0.7) months. Exposure to antenatal PM10 was associated with a decreased lung clearance index (p < 0.01) and postnatally an increase in the difference between resistance at end expiration (ReE) and inspiration (p = 0.05) and decrease in tidal volume (p = 0.06). Exposure to antenatal VOC was associated with an increase in functional residual capacity (p = 0.04) and a decrease in time of expiration over total breath time (tE /tTOT ) (p = 0.03) and postnatally an increase in respiratory rate (p = 0.05). High ETS exposure postnatally was associated with an increase in ReE (p = 0.03). CONCLUSION Antenatal and postnatal IAP and ETS exposures were associated with impairment in lung function at 3 years. Strengthened efforts to reduce IAP and ETS exposure are needed.
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Affiliation(s)
- S. Chaya
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA‐MRC Unit on Child and Adolescent HealthUniversity of Cape TownCape TownSouth Africa
| | - A. Vanker
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA‐MRC Unit on Child and Adolescent HealthUniversity of Cape TownCape TownSouth Africa
| | - K. Brittain
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA‐MRC Unit on Child and Adolescent HealthUniversity of Cape TownCape TownSouth Africa
| | - R. MacGinty
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA‐MRC Unit on Child and Adolescent HealthUniversity of Cape TownCape TownSouth Africa
| | - C. Jacobs
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA‐MRC Unit on Child and Adolescent HealthUniversity of Cape TownCape TownSouth Africa
| | - Z. Hantos
- Department of Anaesthesiology and Intensive TherapySemmelweis UniversityBudapestHungary
| | - H. J. Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA‐MRC Unit on Child and Adolescent HealthUniversity of Cape TownCape TownSouth Africa
| | - D. M. Gray
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA‐MRC Unit on Child and Adolescent HealthUniversity of Cape TownCape TownSouth Africa
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Ziou M, Gao CX, Wheeler AJ, Zosky GR, Stephens N, Knibbs LD, Melody SM, Venn AJ, Dalton MF, Dharmage SC, Johnston FH. Contrasting Health Outcomes following a Severe Smoke Episode and Ambient Air Pollution in Early Life: Findings from an Australian Data Linkage Cohort Study of Hospital Utilization. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:117005. [PMID: 37962441 PMCID: PMC10644899 DOI: 10.1289/ehp12238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Episodic spikes in air pollution due to landscape fires are increasing, and their potential for longer term health impacts is uncertain. OBJECTIVE Our objective is to evaluate associations between exposure in utero and in infancy to severe pollution from a mine fire, background ambient air pollution, and subsequent hospital care. METHODS We linked health records of births, emergency department (ED) visits, and hospitalizations of children born in the Latrobe Valley, Australia, 2012-2015, which included a severe pollution episode from a mine fire (9 February 2014 to 25 March 2014). We assigned modeled exposure estimates for fire-related and ambient particulate matter with an aerodynamic diameter of 2.5 μ m (PM 2.5 ) to residential address. We used logistic regression to estimate associations with hospital visits for any cause and groupings of infectious, allergic, and respiratory conditions. Outcomes were assessed for the first year of life in the in utero cohort and the year following the fire in the infant cohort. We estimated exposure-response for both fire-related and ambient PM 2.5 and also employed inverse probability weighting using the propensity score to compare exposed and not/minimally exposed children. RESULTS Prenatal exposure to fire-related PM 2.5 was associated with ED presentations for allergies/skin rash [odds ratio ( OR ) = 1.34 , 95% confidence interval (CI): 1.01, 1.76 per 240 μ g / m 3 increase]. Exposure in utero to ambient PM 2.5 was associated with overall presentations (OR = 1.18 , 95% CI: 1.05, 1.33 per 1.4 μ g / m 3 ) and visits for infections (ED: OR = 1.13 , 95% CI: 0.98, 1.29; hospitalizations: OR = 1.23 , 95% CI: 1.00, 1.52). Exposure in infancy to fire-related PM 2.5 compared to no/minimal exposure, was associated with ED presentations for respiratory (OR = 1.37 , 95% CI: 1.05, 1.80) and infectious conditions (any: OR = 1.21 , 95% CI: 0.98, 1.49; respiratory-related: OR = 1.39 , 95% CI: 1.05, 1.83). Early life exposure to ambient PM 2.5 was associated with overall ED visits (OR = 1.17 , 95% CI: 1.05, 1.30 per 1.4 μ g / m 3 increase). DISCUSSION Higher episodic and lower ambient concentrations of PM 2.5 in early life were associated with visits for allergic, respiratory, and infectious conditions. Our findings also indicated differences in associations at the two developmental stages. https://doi.org/10.1289/EHP12238.
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Affiliation(s)
- Myriam Ziou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Caroline X. Gao
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Amanda J. Wheeler
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Oceans and Atmosphere, Aspendale, Victoria, Australia
| | - Graeme R. Zosky
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- Tasmanian School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Nicola Stephens
- Tasmanian School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Luke D. Knibbs
- School of Public Health, The University of Sydney, New South Wales, Australia
- Public Health Research Analytics and Methods for Evidence, Public Health Unit, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Shannon M. Melody
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Alison J. Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Marita F. Dalton
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Shyamali C. Dharmage
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Fay H. Johnston
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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10
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Marsal A, Slama R, Lyon-Caen S, Borlaza LJS, Jaffrezo JL, Boudier A, Darfeuil S, Elazzouzi R, Gioria Y, Lepeule J, Chartier R, Pin I, Quentin J, Bayat S, Uzu G, Siroux V, the SEPAGES cohort study group. Prenatal Exposure to PM2.5 Oxidative Potential and Lung Function in Infants and Preschool- Age Children: A Prospective Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:17004. [PMID: 36695591 PMCID: PMC9875724 DOI: 10.1289/ehp11155] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 11/29/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Fine particulate matter (PM 2.5 ) has been found to be detrimental to respiratory health of children, but few studies have examined the effects of prenatal PM 2.5 oxidative potential (OP) on lung function in infants and preschool children. OBJECTIVES We estimated the associations of personal exposure to PM 2.5 and OP during pregnancy on offspring objective lung function parameters and compared the strengths of associations between both exposure metrics. METHODS We used data from 356 mother-child pairs from the SEPAGES cohort. PM filters collected twice during a week were analyzed for OP, using the dithiothreitol (DTT) and the ascorbic acid (AA) assays, quantifying the exposure of each pregnant woman. Lung function was assessed with tidal breathing analysis (TBFVL) and nitrogen multiple-breath washout (N 2 MBW ) test, performed at 6 wk, and airwave oscillometry (AOS) performed at 3 y. Associations of prenatal PM 2.5 mass and OP with lung function parameters were estimated using multiple linear regressions. RESULTS In neonates, an interquartile (IQR) increase in OP v DTT (0.89 nmol / min / m 3 ) was associated with a decrease in functional residual capacity (FRC) measured by N 2 MBW [β = - 2.26 mL ; 95% confidence interval (CI): - 4.68 , 0.15]. Associations with PM 2.5 showed similar patterns in comparison with OP v DTT but of smaller magnitude. Lung clearance index (LCI) and TBFVL parameters did not show any clear association with the exposures considered. At 3 y, increased frequency-dependent resistance of the lungs (Rrs 7 - 19 ) from AOS tended to be associated with higher OP v DTT (β = 0.09 hPa × s / L ; 95% CI: - 0.06 , 0.24) and OP v AA (IQR = 1.14 nmol / min / m 3 ; β = 0.12 hPa × s / L ; 95% CI: - 0.04 , 0.27) but not with PM 2.5 (IQR = 6.9 μ g / m 3 ; β = 0.02 hPa × s / L ; 95% CI: - 0.13 , 0.16). Results for FRC and Rrs 7 - 19 remained similar in OP models adjusted on PM 2.5 . DISCUSSION Prenatal exposure to OP v DTT was associated with several offspring lung function parameters over time, all related to lung volumes. https://doi.org/10.1289/EHP11155.
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Affiliation(s)
- Anouk Marsal
- Université Grenoble Alpes, Centre national de la recherche scientifique (CNRS), INRAE, IRD, INP-G, IGE (UMR 5001), Grenoble, France
- Agence de l’environnement et de la Maîtrise de l’Energie, Angers, France
| | - Rémy Slama
- Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, Inserm U 1209, CNRS UMR 5309, Université Grenoble Alpes, 38000 Grenoble, France
| | - Sarah Lyon-Caen
- Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, Inserm U 1209, CNRS UMR 5309, Université Grenoble Alpes, 38000 Grenoble, France
| | - Lucille Joanna S. Borlaza
- Université Grenoble Alpes, Centre national de la recherche scientifique (CNRS), INRAE, IRD, INP-G, IGE (UMR 5001), Grenoble, France
| | - Jean-Luc Jaffrezo
- Université Grenoble Alpes, Centre national de la recherche scientifique (CNRS), INRAE, IRD, INP-G, IGE (UMR 5001), Grenoble, France
| | - Anne Boudier
- Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, Inserm U 1209, CNRS UMR 5309, Université Grenoble Alpes, 38000 Grenoble, France
- Pediatric Department, CHU Grenoble Alpes, Grenoble, France
| | - Sophie Darfeuil
- Université Grenoble Alpes, Centre national de la recherche scientifique (CNRS), INRAE, IRD, INP-G, IGE (UMR 5001), Grenoble, France
| | - Rhabira Elazzouzi
- Université Grenoble Alpes, Centre national de la recherche scientifique (CNRS), INRAE, IRD, INP-G, IGE (UMR 5001), Grenoble, France
| | - Yoann Gioria
- Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, Inserm U 1209, CNRS UMR 5309, Université Grenoble Alpes, 38000 Grenoble, France
| | - Johanna Lepeule
- Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, Inserm U 1209, CNRS UMR 5309, Université Grenoble Alpes, 38000 Grenoble, France
| | - Ryan Chartier
- RTI International, Research Triangle Park, North Carolina, USA
| | - Isabelle Pin
- Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, Inserm U 1209, CNRS UMR 5309, Université Grenoble Alpes, 38000 Grenoble, France
- Pediatric Department, CHU Grenoble Alpes, Grenoble, France
| | - Joane Quentin
- Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, Inserm U 1209, CNRS UMR 5309, Université Grenoble Alpes, 38000 Grenoble, France
- Department of Pulmonology and Physiology, CHU Grenoble Alpes, Grenoble, France
| | - Sam Bayat
- Department of Pulmonology and Physiology, CHU Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, Inserm UA07 STOBE Laboratory, Grenoble, France
| | - Gaëlle Uzu
- Université Grenoble Alpes, Centre national de la recherche scientifique (CNRS), INRAE, IRD, INP-G, IGE (UMR 5001), Grenoble, France
| | - Valérie Siroux
- Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, Inserm U 1209, CNRS UMR 5309, Université Grenoble Alpes, 38000 Grenoble, France
| | - the SEPAGES cohort study group
- Université Grenoble Alpes, Centre national de la recherche scientifique (CNRS), INRAE, IRD, INP-G, IGE (UMR 5001), Grenoble, France
- Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, Inserm U 1209, CNRS UMR 5309, Université Grenoble Alpes, 38000 Grenoble, France
- Pediatric Department, CHU Grenoble Alpes, Grenoble, France
- Department of Pulmonology and Physiology, CHU Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, Inserm UA07 STOBE Laboratory, Grenoble, France
- RTI International, Research Triangle Park, North Carolina, USA
- Agence de l’environnement et de la Maîtrise de l’Energie, Angers, France
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11
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Dai X, Dharmage SC, Lodge CJ. The relationship of early-life household air pollution with childhood asthma and lung function. Eur Respir Rev 2022; 31:220020. [PMID: 38743526 DOI: 10.1183/16000617.0020-2022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 06/29/2022] [Indexed: 11/05/2022] Open
Abstract
The increase in childhood asthma over the past few decades has made it an important public health issue. Poor lung function growth associated with some phenotypes of asthma compounds its long-term impact on the individual. Exposure to early-life household risk factors is believed to be linked with respiratory health while infants' lungs are still developing. This review summarises epidemiological studies and mechanistic evidence focusing on the detrimental effects of early-life household air exposures on the respiratory health of children, in particular effects on asthma and lung function. Many early-life household air exposures, including tobacco smoke, gases from heating and cooking, mould/dampness and cleaning products are associated with childhood asthma development and lung function growth. These exposures may alter structural and mechanical characteristics of infants' lungs and contribute to deficits in later life. In addition, some risk factors, including tobacco smoke and cleaning products, can transmit effects across generations to increase the risk of asthma in subsequent generations. This review supports the hypothesis that risks of asthma and accelerated lung ageing are established in early life. The timing of exposure may be critical in the pathogenesis of respiratory diseases, in terms of future risk of asthma and reduced lung function in adults.
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Affiliation(s)
- Xin Dai
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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12
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Gheissari R, Liao J, Garcia E, Pavlovic N, Gilliland FD, Xiang AH, Chen Z. Health Outcomes in Children Associated with Prenatal and Early-Life Exposures to Air Pollution: A Narrative Review. TOXICS 2022; 10:toxics10080458. [PMID: 36006137 PMCID: PMC9415268 DOI: 10.3390/toxics10080458] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/25/2022] [Accepted: 08/03/2022] [Indexed: 06/04/2023]
Abstract
(1) Background: The developmental origins of health and disease (DOHaD) hypothesis links adverse fetal exposures with developmental mal-adaptations and morbidity later in life. Short- and long-term exposures to air pollutants are known contributors to health outcomes; however, the potential for developmental health effects of air pollution exposures during gestation or early-childhood have yet to be reviewed and synthesized from a DOHaD lens. The objective of this study is to summarize the literature on cardiovascular and metabolic, respiratory, allergic, and neuropsychological health outcomes, from prenatal development through early childhood, associated with early-life exposures to outdoor air pollutants, including traffic-related and wildfire-generated air pollutants. (2) Methods: We conducted a search using PubMed and the references of articles previously known to the authors. We selected papers that investigated health outcomes during fetal or childhood development in association with early-life ambient or source-specific air pollution exposure. (3) Results: The current literature reports that prenatal and early-childhood exposures to ambient and traffic-related air pollutants are associated with a range of adverse outcomes in early life, including cardiovascular and metabolic, respiratory and allergic, and neurodevelopmental outcomes. Very few studies have investigated associations between wildfire-related air pollution exposure and health outcomes during prenatal, postnatal, or childhood development. (4) Conclusion: Evidence from January 2000 to January 2022 supports a role for prenatal and early-childhood air pollution exposures adversely affecting health outcomes during development. Future studies are needed to identify both detrimental air pollutants from the exposure mixture and critical exposure time periods, investigate emerging exposure sources such as wildfire, and develop feasible interventional tools.
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Affiliation(s)
- Roya Gheissari
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033, USA
| | - Jiawen Liao
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033, USA
| | - Erika Garcia
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033, USA
| | - Nathan Pavlovic
- Sonoma Technology Inc., 1450 N. McDowell Blvd., Suite 200, Petaluma, CA 94954, USA
| | - Frank D. Gilliland
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033, USA
| | - Anny H. Xiang
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA 91107, USA
| | - Zhanghua Chen
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033, USA
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13
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Ranzani OT, Bhogadi S, Milà C, Kulkarni B, Balakrishnan K, Sambandam S, Garcia-Aymerich J, Marshall JD, Kinra S, Tonne C. Association of ambient and household air pollution with lung function in young adults in an peri-urban area of South-India: A cross-sectional study. ENVIRONMENT INTERNATIONAL 2022; 165:107290. [PMID: 35594814 DOI: 10.1016/j.envint.2022.107290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/04/2022] [Accepted: 05/09/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Although there is evidence for the association between air pollution and decreased lung function in children, evidence for adolescents and young adults is scarce. For a peri-urban area in India, we evaluated the association of ambient PM2.5 and household air pollution with lung function for young adults who had recently attained their expected maximum lung function. METHODS We measured, using a standardized protocol, forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) in participants aged 20-26 years from the third follow-up of the population-based APCAPCS cohort (2010-2012) in 28 Indian villages. We estimated annual average PM2.5outdoors at residence using land-use regression. Biomass cooking fuel (a proxy for levels of household air pollution) was self-reported. We fitted a within-between linear-mixed model with random intercepts by village, adjusting for potential confounders. RESULTS We evaluated 1,044 participants with mean age of 22.8 (SD = 1) years (range 20-26 years); 327 participants (31%) were female. Only males reported use of tobacco smoking (9% of all participants, 13% of males). The mean ambient PM2.5 exposure was 32.9 (SD = 2.8) µg/m3; 76% reported use of biomass as cooking fuel. The adjusted association between 1 µg/m3 increase in PM2.5 was -27 ml (95% CI, -89 to 34) for FEV1 and -5 ml (95% CI, -93 to 76) for FVC. The adjusted association between use of biomass was -112 ml (95% CI, -211 to -13) for FEV1 and -142 ml (95% CI, -285 to 0) for FVC. The adjusted association was of greater magnitude for those with unvented stove (-158 ml, 95% CI, -279 to -36 for FEV1 and -211 ml, 95% CI, -386 to -36 for FVC). CONCLUSIONS We observed negative associations between ambient PM2.5 and household air pollution and lung function in young adults who had recently attained their maximum lung function.
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Affiliation(s)
- Otavio T Ranzani
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain
| | | | - Carles Milà
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Bharati Kulkarni
- National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India
| | - Kalpana Balakrishnan
- Department of Environmental Health Engineering, Sri Ramachandra University (SRU), Chennai, India
| | - Sankar Sambandam
- Department of Environmental Health Engineering, Sri Ramachandra University (SRU), Chennai, India
| | - Judith Garcia-Aymerich
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Julian D Marshall
- Department of Civil and Environmental Engineering, University of Washington, Seattle, WA, USA
| | - Sanjay Kinra
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Cathryn Tonne
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain.
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14
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Chaya S, Zar HJ, Gray DM. Lung Function in Preschool Children in Low and Middle Income Countries: An Under-Represented Potential Tool to Strengthen Child Health. Front Pediatr 2022; 10:908607. [PMID: 35769219 PMCID: PMC9234953 DOI: 10.3389/fped.2022.908607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/10/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The burden of respiratory disease is high in low-middle income countries (LMIC). Pulmonary function tests are useful as an objective measure of lung health and to track progression. Spirometry is the commonest test, but its use is limited in preschool children. Other lung function methods have been developed but their use in LMIC has not been well described. AIM To review the use of preschool lung function testing in children in LMIC, with particular reference to feasibility and clinical applications. METHODS Electronic databases "PubMed", "Scopus"," Web of Science", and "EBSCO host" were searched for publications in low and middle income countries on preschool lung function testing, including spirometry, fractional exhaled nitric oxide (FeNO), oscillometry, interrupter technique, tidal breathing and multiple breath washout (MBW), from 1 January 2011 to 31 January 2022. Papers in English were included and those including only children ≥6 years were excluded. RESULT A total of 61 papers from LMIC in Asia, South America, Africa, Eurasia or the Middle East were included. Of these, 40 included spirometry, 7 FeNO, 15 oscillometry, 2 interrupter technique, and 2 tidal breathing. The papers covered test feasibility (19/61), clinical application (46/61) or epidemiological studies (13/61). Lung function testing was successful in preschool children from LMIC. Spirometry was the most technically demanding and success gradually increased with age. CONCLUSION Preschool lung function testing is under-represented in LMIC for the burden of respiratory disease. These tests have the potential to strengthen respiratory care in LMIC, however access needs to be improved.
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Affiliation(s)
- Shaakira Chaya
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Diane M Gray
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
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