The relationship of early-life household air pollution with childhood asthma and lung function

Effects of household cleaning products on the lungs: an update

INTRODUCTION

Household disinfectants and cleaning products (HDCPs), which involve a complex mixture of chemical ingredients, are commonly used in homes. HDCPs significantly contribute to chemical exposure in the indoor environment by releasing particles and volatile organic compounds while being used, potentially harming the respiratory health of those exposed.

AREAS COVERED

We provide an overview of scientific literature, especially from the last five years, regarding the (i) effects of using of HDCPs on adults' respiratory health; (ii) associations between prenatal or childhood exposure to HDCPs and children respiratory health. Finally, we discuss on standard and innovative methods of HDCP exposure assessment.

EXPERT OPINION

Recent literature provides further evidence on the harmful role of HDCPs on respiratory health in both adults and children. Exposure to HDCPs is a modifiable asthma risk factor that requires more consideration, in order to reduce asthma-related morbidity, and to improve and maintain an optimal control of the disease. Further research is essential to deepen the current knowledge, particularly by using innovative methods of exposure assessment to HDCPs, which could enhance the exposure characterization in both adults and children, and contribute to identify HDCP's chemical compounds leading to a risk for respiratory health.

Dietary Patterns in Relation to Asthma and Wheeze Among Adolescents in a South African Rural Community

BACKGROUND

The rise of asthma prevalence in recent decades has been attributed to changes in dietary patterns, especially in developing countries. Studies have also suggested that dietary patterns play an important role in both asthma development and management. This study aimed to investigate the association between consumption of various foods and environmental factors with asthma and wheeze among adolescents.

METHODS

A self-administered standardized International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was used to collect data on demographics, respiratory health, exposure to air pollution, and diet on n = 2855 adolescents residing in Vhembe District, South Africa.

RESULTS

The prevalence of asthma and wheeze were 18.91% and 37.69%, respectively. Consuming various foods such as fast foods (OR = 1.41; 95% CI: 1.06-1.88), bread (OR = 0.60; 95% CI: 0.45-1.81), pasta (OR = 1.39; 95% CI: 1.06-1.84), seafood (OR = 1.79; 95% CI: 0.65-1.24), and nuts (OR = 0.85; 95% CI: 0.65-1.12) were significantly associated with asthma in the crude logistic regression analysis. Further analysis in the multiple regression model indicated a strong association of asthma with consumption of nuts (OR = 1.55; 95% CI: 1.11-2.17), seafood (OR = 1.60; 95% CI: 1.03-2.49), and cereal (OR = 0.67; 95% CI: 0.45-0.99). In relation to wheeze, consumption of meat (red) (OR = 0.77; 95% CI: 0.60-0.99) was a protective factor in the crude analysis. The multiple logistic regression model showed that, seafood (OR = 0.76; 95% CI: 0.59-0.96), fruit (OR = 0.55; 95% CI: 0.32-0.94), nuts (OR = 1.88; 95% CI: 1.50-2.66), and olive oil (OR = 1.48; 95% CI: 1.09-2.00) were significantly associated with wheeze.

CONCLUSION

Diet plays a major role in respiratory health, especially in asthma and wheeze. Dietary changes may play a role in reducing the burden of asthma and other respiratory symptoms in adolescents.

Household air pollution and respiratory health in Africa: persistent risk and unchanged health burdens

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.

Household fuel use and severe asthma symptoms among preschool children in Gauteng province, South Africa: a cross-sectional study

Background

Household air pollution continues to be a major public health hazard due to the continued use of household fuel sources. Globally, approximately 4 million people die prematurely each year due to exposure to household air pollution sources. Children are more susceptible to health effects associated with air pollution because their immune systems and lungs are not fully developed.

Objective

The objective of the study was to investigate the association between household fuel use and current severe asthma symptoms among preschool children in Gauteng province, South Africa.

Methods

This was a cross-sectional study conducted in the City of Tshwane Metropolitan Municipality in Gauteng province, South Africa. A total of 1844 parents and guardians of preschool children completed the modified International Study of Asthma and Allergies in Childhood questionnaire. However, a total of four questionnaires were discarded due to incorrect completion. Therefore, a total of 1840 questionnaires were included in the data analysis. Data were analysed using multiple logistic regression analysis.

Results

The prevalence of current severe asthma symptoms was 15.4%. The use of gas for cooking or heating significantly increased the likelihood of current severe asthma symptoms among preschool children (OR=3.20;95% CI 2.08 to 4.91; p<0.001). The use of open fire sources (paraffin, wood or coal) increased the likelihood of severe asthma symptoms among preschool children by 87% (95% CI 0.98 to 3.55; p=0.057).

Conclusion

The study observed that using gas and open fire sources for cooking or heating was associated with current severe asthma symptoms among preschool children in Gauteng, South Africa. Household air quality regulations should be developed to mitigate child exposure to household air pollution in the study setting.

Visible damp in a child's bedroom is associated with increased respiratory morbidity in early life: a multicentre cohort study

OBJECTIVE

Household damp exposure is an important public health issue. We aimed to assess the impact of the location of household damp on respiratory outcomes during early life.

METHODS

Household damp exposure was ascertained in children recruited to the GO-CHILD multicentre birth cohort study. The frequency of respiratory symptoms, infections, healthcare utilisation and medication prescription for wheezing were collected by postal questionnaires at 12 and 24 months. Log binomial and ordered logistic regression models were fitted to the data.

RESULTS

Follow-up was obtained in 1344 children between August 2010 and January 2016. Visible damp was present in a quarter of households (25.3%) with 1 in 12 children's bedrooms affected (8.3%). Damp in the bathroom, kitchen or living room was not associated with any respiratory or infection-related outcomes. Damp in the child's bedroom was associated with an increased risk of dry cough (8.7% vs 5.7%) (adjusted relative risk 1.56, 95% CI 1.07 to 2.27; p=0.021) and odds of primary care attendance for cough and wheeze (7.6% vs 4.4%) (adjusted OR 1.37, 95% CI 1.07 to 1.76; p=0.009). There were also increased risk of inhaled corticosteroid (13.3% vs 5.9%) (adjusted RR 2.22, 95% CI 1.04 to 4.74; p=0.038) and reliever inhaler (8.3% vs 5.8%) (adjusted RR 2.01, 95% CI 1.21 to 2.79; p=0.018) prescription.

CONCLUSION

Damp in the child's bedroom was associated with increased respiratory morbidity. In children presenting with recurrent respiratory symptoms, clinicians should enquire about both the existence and location of damp, the presence of which can help prioritise those families requiring urgent household damp assessment and remediation works.

The incidence of upper respiratory infections in children is related to the concentration of vanadium in indoor dust aggregates

Background

It has been reported that the disease-initiated and disease-mediated effects of aerosol pollutants can be related to concentration, site of deposition, duration of exposure, as well as the specific chemical composition of pollutants.

Objectives

To investigate the microelemental composition of dust aggregates in primary schools of Vilnius and determine trace elements related to acute upper respiratory infections among 6-to 11-year-old children.

Methods

Microelemental analysis of aerosol pollution was performed using dust samples collected in the classrooms of 11 primary schools in Vilnius from 2016 to 2020. Sites included areas of its natural accumulation behind the radiator heaters and from the surface of high cupboards. The concentrations of heavy metals (Pb, W, Sb, Sn, Zr, Zn, Cu, Ni, Mn, Cr, V, and As) in dust samples were analyzed using a SPECTRO XEPOS spectrometer. The annual incidence rates of respiratory diseases in children of each school were calculated based on data from medical records.

Results

The mean annual incidence of physician-diagnosed acute upper respiratory infections (J00-J06 according to ICD-10A) among younger school-age children was between 25.1 and 71.3% per school. A significant correlation was found between vanadium concentration and the number of episodes of acute upper respiratory infections during each study year from 2016 to 2020. The lowest was r = 0.67 (p = 0.024), and the highest was r = 0.82 (p = 0.002). The concentration of vanadium in the samples of dust aggregates varied from 12.7 to 52.1 parts per million (ppm). No significant correlations between the other trace elements and the incidence of upper respiratory infections were found, which could be caused by a small number of study schools and relatively low concentrations of other heavy metals found in the samples of indoor dust aggregates.

Conclusion

A significant and replicable correlation was found between the concentration of vanadium in the samples of natural dust aggregates collected in primary schools and the incidence of acute upper respiratory infections in children. Monitoring the concentration of heavy metals in the indoor environment can be an important instrument for the prevention and control of respiratory morbidity in children.

The impact of perinatal and at birth risk factors on the progression from preschool wheezing to adolescent asthma

Asthma is a global health concern affecting millions of children and adolescents. This review focuses on the possible factors that are associated with the transition from preschool wheezing to childhood asthma and highlights the significance of early-life environmental exposures during pregnancy and the first 6 months of life in shaping allergies and asthma. We observed a scarcity of studies investigating this subgroup, with most focusing on wheezing trajectories. We undertook a thorough investigation of diverse perinatal exposures that have the potential to impact this transition. These factors include maternal asthma, smoking during pregnancy, diet, prepregnancy weight, infant birthweight, gestational age, and breastfeeding. Although limited, studies do suggest that maternal asthma increases the likelihood of preschool wheeze in offspring that persists through childhood with potential asthma progression. Findings concerning other perinatal exposures remain inconsistent. Further research is needed to identify asthma progression risk factors and assess perinatal exposure effects.

Environmental risk factors for respiratory infection and wheeze in young children: A multicentre birth cohort study

INTRODUCTION

Respiratory infections and wheeze have a considerable impact on the health of young children and consume significant healthcare resources. We aimed to evaluate the effect of environmental factors on respiratory infections and symptoms in early childhood.

METHODS

Environmental risk factors including: daycare attendance; breastfeeding; siblings; damp within the home; environmental tobacco smoke (ETS); child's bedroom flooring; animal exposure; road traffic density around child's home; and solid fuel pollution within home were assessed in children recruited to the GO-CHILD multicentre prospective birth cohort study. Follow-up information on respiratory infections (bronchiolitis, pneumonia, otitis media and cold or flu), wheeze and cough symptoms, healthcare utilisation and medication prescription was collected by postal questionnaires at 12 and 24 months. Log binomial and ordered logistic regression models were fitted to the data.

RESULTS

Follow-up was obtained on 1344 children. Daycare was associated with increased odds of pneumonia (odds ratio [OR] = 2.39, 95% confidence interval [CI]: 1.04-5.49), bronchiolitis (OR = 1.40, 1.02-1.90), otitis media (OR = 1.68, 1.32-2.14) and emergency department attendance for wheeze (RR = 1.81, 1.17-2.80). Breastfeeding beyond 6 months was associated with a reduced odds of bronchiolitis (OR = 0.55, 0.39-0.77) and otitis media (OR = 0.75, 0.59-0.99). Siblings at home was associated with an increased odds of bronchiolitis (OR = 1.65, 1.18-2.32) and risk of reliever inhaler prescription (RR = 1.37, 1.02-1.85). Visible damp was associated with an increased odds of wheeze (OR = 1.85, 1.11-3.19), and risk of reliever inhaler (RR = 1.73, 1.04-2.89) and inhaled corticosteroid prescription (RR = 2.61, 1.03-6.59). ETS exposure was associated with an increased odds of primary care attendance for cough or wheeze (OR = 1.52, 1.11-2.08). Dense traffic around the child's home was associated with an increased odds of bronchiolitis (OR = 1.32, 1.08-2.29).

CONCLUSION

Environmental factors likely influence the wide variation in infection frequency and symptoms observed in early childhood. Larger population studies are necessary to further inform and guide public health policy to decrease the burden of respiratory infections and wheeze in young children.

Responses of schoolchildren with asthma to recommendations to reduce desert dust exposure: Results from the LIFE-MEDEA intervention project using wearable technology

Current public health recommendations for desert dust storms (DDS) events focus on vulnerable population groups, such as children with asthma, and include advice to stay indoors and limit outdoor physical activity. To date, no scientific evidence exists on the efficacy of these recommendations in reducing DDS exposure. We aimed to objectively assess the behavioral responses of children with asthma to recommendations for reduction of DDS exposure. In two heavily affected by DDS Mediterranean regions (Cyprus & Crete, Greece), schoolchildren with asthma (6-11 years) were recruited from primary schools and were randomized to control (business as usual scenario) and intervention groups. All children were equipped with pedometer and GPS sensors embedded in smartwatches for objective real-time data collection from inside and outside their classroom and household settings. Interventions included the timely communication of personal DDS alerts accompanied by exposure reduction recommendations to both the parents and school-teachers of children in the intervention group. A mixed effect model was used to assess changes in daily levels of time spent, and steps performed outside classrooms and households, between non-DDS and DDS days across the study groups. The change in the time spent outside classrooms and homes, between non-DDS and DDS days, was 37.2 min (p_value = 0.098) in the control group and -62.4 min (p_value < 0.001) in the intervention group. The difference in the effects between the two groups was statistically significant (interaction p_value < 0.001). The change in daily steps performed outside classrooms and homes, was -495.1 steps (p_value = 0.350) in the control group and -1039.5 (p_value = 0.003) in the intervention group (interaction p_value = 0.575). The effects on both the time and steps performed outside were more profound during after-school hours. To summarize, among children with asthma, we demonstrated that timely personal DDS alerts and detailed recommendations lead to significant behavioral changes in contrast to the usual public health recommendations.