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Chang AB, Kovesi T, Redding GJ, Wong C, Alvarez GG, Nantanda R, Beltetón E, Bravo-López M, Toombs M, Torzillo PJ, Gray DM. Chronic respiratory disease in Indigenous peoples: a framework to address inequity and strengthen respiratory health and health care globally. THE LANCET. RESPIRATORY MEDICINE 2024:S2213-2600(24)00008-0. [PMID: 38677306 DOI: 10.1016/s2213-2600(24)00008-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 01/04/2024] [Accepted: 01/12/2024] [Indexed: 04/29/2024]
Abstract
Indigenous peoples around the world bear a disproportionate burden of chronic respiratory diseases, which are associated with increased risks of morbidity and mortality. Despite the imperative to address global inequity, research focused on strengthening respiratory health in Indigenous peoples is lacking, particularly in low-income and middle-income countries. Drivers of the increased rates and severity of chronic respiratory diseases in Indigenous peoples include a high prevalence of risk factors (eg, prematurity, low birthweight, poor nutrition, air pollution, high burden of infections, and poverty) and poor access to appropriate diagnosis and care, which might be linked to colonisation and historical and current systemic racism. Efforts to tackle this disproportionate burden of chronic respiratory diseases must include both global approaches to address contributing factors, including decolonisation of health care and research, and local approaches, co-designed with Indigenous people, to ensure the provision of culturally strengthened care with more equitable prioritisation of resources. Here, we review evidence on the burden of chronic respiratory diseases in Indigenous peoples globally, summarise factors that underlie health disparities between Indigenous and non-Indigenous people, propose a framework of approaches to improve the respiratory health of Indigenous peoples, and outline future directions for clinical care and research.
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Affiliation(s)
- Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia; NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
| | - Tom Kovesi
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Gregory J Redding
- School of Medicine, University of Washington, Seattle, WA, USA; Pediatric Pulmonary Division, Seattle Children's Hospital, Seattle, WA, USA
| | - Conroy Wong
- Department of Respiratory Medicine, Te Whatu Ora Counties Manukau, Auckland, New Zealand; School of Medicine, University of Auckland, Auckland, New Zealand
| | - Gonzalo G Alvarez
- Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Rebecca Nantanda
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Edgar Beltetón
- Centro Pediátrico de Guatemala, Guatemala City, Guatemala
| | - Maynor Bravo-López
- Centro Pediátrico de Guatemala, Guatemala City, Guatemala; Department of Pediatrics, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Maree Toombs
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Paul J Torzillo
- Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia; Nganampa Health Council, Alice Springs, NT, Australia
| | - Diane M Gray
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Kearns KA, Naeher LP, McCracken JP, Boyd Barr D, Saikawa E, Hengstermann M, Mollinedo E, Panuwet P, Yakimavets V, Lee GE, Thompson LM. Estimating personal exposures to household air pollution and plastic garbage burning among adolescent girls in Jalapa, Guatemala. CHEMOSPHERE 2024; 348:140705. [PMID: 37981014 PMCID: PMC10714129 DOI: 10.1016/j.chemosphere.2023.140705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/10/2023] [Accepted: 11/11/2023] [Indexed: 11/21/2023]
Abstract
Waste collection services are uncommon in rural areas of low-resource countries, causing waste accumulation and subsequent dumping and burning of garbage. Air pollution from household garbage burning, including plastics, has been observed in Jalapa, Guatemala in addition to household air pollution (HAP) from cooking. Adolescent girls often help with these cooking and household tasks, but little is known about their exposures. We characterized 24-h exposures to HAP and household garbage burning in adolescent girls by measuring fine particulate matter (PM2.5), black carbon (BC), urinary biomarkers of polycyclic aromatic hydrocarbons (PAHs), bisphenol A (BPA), and phthalates. We recruited 60 girls between 13 and 17 years of age who helped with cooking activities and lived with participants of the Household Air Pollution Intervention Network (HAPIN) trial. We recruited n = 30 girls each from the control (wood-burning stove) and intervention (liquefied petroleum gas stove) arms. We also measured real-time kitchen concentrations of BC in 20 homes (33%). PM2.5 and BC were measured in n = 21 control and n = 20 intervention participants. Median concentrations of personal PM2.5 and BC and kitchen BC were lower (p < 0.05) in the intervention arm by 87%, 80%, and 85%, respectively. PAH metabolite concentrations were lower (p < 0.001) for all nine metabolites in intervention (n = 26) compared to control participants (n = 29). Urinary BPA concentrations were 66% higher in participants who reported using cosmetics (p = 0.02), and phthalate concentrations were 63% higher in participants who had reported using hair products during the sample period (p = 0.05). Our results suggest that gas stoves can reduce HAP exposures among adolescents who are not primary cooks at home. Biomarkers of plastic exposure were not associated with intervention status, but some were elevated compared to age- and sex-matched participants of the National Health and Nutrition Examination Survey (NHANES).
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Affiliation(s)
- Katherine A Kearns
- University of Georgia, Department of Environmental Health Science, College of Public Health, Athens, GA, USA
| | - Luke P Naeher
- University of Georgia, Department of Environmental Health Science, College of Public Health, Athens, GA, USA
| | - John P McCracken
- University of Georgia, Department of Environmental Health Science, College of Public Health, Athens, GA, USA; Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Dana Boyd Barr
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Eri Saikawa
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Mayari Hengstermann
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Erick Mollinedo
- University of Georgia, Department of Environmental Health Science, College of Public Health, Athens, GA, USA; Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Parinya Panuwet
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Volha Yakimavets
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Grace E Lee
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lisa M Thompson
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA.
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Byanova KL, Abelman R, North CM, Christenson SA, Huang L. COPD in People with HIV: Epidemiology, Pathogenesis, Management, and Prevention Strategies. Int J Chron Obstruct Pulmon Dis 2023; 18:2795-2817. [PMID: 38050482 PMCID: PMC10693779 DOI: 10.2147/copd.s388142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/09/2023] [Indexed: 12/06/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder characterized by airflow limitation and persistent respiratory symptoms. People with HIV (PWH) are particularly vulnerable to COPD development; PWH have demonstrated both higher rates of COPD and an earlier and more rapid decline in lung function than their seronegative counterparts, even after accounting for differences in cigarette smoking. Factors contributing to this HIV-associated difference include chronic immune activation and inflammation, accelerated aging, a predilection for pulmonary infections, alterations in the lung microbiome, and the interplay between HIV and inhalational toxins. In this review, we discuss what is known about the epidemiology and pathobiology of COPD among PWH and outline screening, diagnostic, prevention, and treatment strategies.
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Affiliation(s)
- Katerina L Byanova
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Rebecca Abelman
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Crystal M North
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Stephanie A Christenson
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Laurence Huang
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Kizhakke Puliyakote AS, Stapleton EM, Durairaj K, Karuppusamy K, Kathiresan GB, Shanmugam K, Abdul Rahim S, Navaneethakrishnan S, Bilas M, Huang R, Metwali N, Jeronimo M, Chan KS, Guo J, Nagpal P, Peters TM, Thorne PS, Comellas AP, Hoffman EA. Imaging-based assessment of lung function in a population cooking indoors with biomass fuel: a pilot study. J Appl Physiol (1985) 2023; 134:710-721. [PMID: 36759166 PMCID: PMC10027118 DOI: 10.1152/japplphysiol.00286.2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023] Open
Abstract
Biomass fuels (wood) are commonly used indoors in underventilated environments for cooking in the developing world, but the impact on lung physiology is poorly understood. Quantitative computed tomography (qCT) can provide sensitive metrics to compare the lungs of women cooking with wood vs. liquified petroleum gas (LPG). We prospectively assessed (qCT and spirometry) 23 primary female cooks (18 biomass, 5 LPG) with no history of cardiopulmonary disease in Thanjavur, India. CT was obtained at coached total lung capacity (TLC) and residual volume (RV). qCT assessment included texture-derived ground glass opacity [GGO: Adaptive Multiple Feature Method (AMFM)], air-trapping (expiratory voxels ≤ -856HU) and image registration-based assessment [Disease Probability Measure (DPM)] of emphysema, functional small airways disease (%AirTrapDPM), and regional lung mechanics. In addition, within-kitchen exposure assessments included particulate matter <2.5 μm(PM2.5), black carbon, β-(1, 3)-d-glucan (surrogate for fungi), and endotoxin. Air-trapping went undetected at RV via the threshold-based measure (voxels ≤ -856HU), possibly due to density shifts in the presence of inflammation. However, DPM, utilizing image-matching, demonstrated significant air-trapping in biomass vs. LPG cooks (P = 0.049). A subset of biomass cooks (6/18), identified using k-means clustering, had markedly altered DPM-metrics: greater air-trapping (P < 0.001), lower TLC-RV volume change (P < 0.001), a lower mean anisotropic deformation index (ADI; P < 0.001), and elevated % GGO (P < 0.02). Across all subjects, a texture measure of bronchovascular bundles was correlated to the log-transformed β-(1, 3)-d-glucan concentration (P = 0.026, R = 0.46), and black carbon (P = 0.04, R = 0.44). This pilot study identified environmental links with qCT-based lung pathologies and a cluster of biomass cooks (33%) with significant small airways disease.NEW & NOTEWORTHY Quantitative computed tomography has identified a cluster of women (33%) cooking with biomass fuels (wood) with image-based markers of functional small airways disease and associated alterations in regional lung mechanics. Texture and image registration-based metrics of lung function may allow for early detection of potential inflammatory processes that may arise in response to inhaled biomass smoke, and help identify phenotypes of chronic lung disease prevalent in nonsmoking women in the developing world.
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Affiliation(s)
- Abhilash S Kizhakke Puliyakote
- Department of Radiology, University of California, San Diego, La Jolla, California, United States
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, United States
| | - Emma M Stapleton
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States
| | - Kumar Durairaj
- Department of Physics, Periyar Maniammai Institute of Science and Technology, Thanjavur, India
| | - Kesavan Karuppusamy
- Department of Physics, Periyar Maniammai Institute of Science and Technology, Thanjavur, India
| | - Geetha B Kathiresan
- Department of Electronics and Communication Engineering, Periyar Maniammai Institute of Science and Technology, Thanjavur, India
| | - Kumaran Shanmugam
- Department of Biotechnology, Periyar Maniammai Institute of Science and Technology, Thanjavur, India
| | | | | | - Monalisa Bilas
- Department of Radiology, University of Iowa, Iowa City, Iowa, United States
| | - Rui Huang
- School of Economics, Nanjing University, Nanjing, People's Republic of China
| | - Nervana Metwali
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, Iowa, United States
| | - Matthew Jeronimo
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kung-Sik Chan
- Department of Statistics and Actuarial Science, University of Iowa, Iowa City, Iowa, United States
| | - Junfeng Guo
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, United States
- Department of Radiology, University of Iowa, Iowa City, Iowa, United States
| | - Prashant Nagpal
- Department of Radiology, University of Iowa, Iowa City, Iowa, United States
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Thomas M Peters
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, Iowa, United States
| | - Peter S Thorne
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, Iowa, United States
| | - Alejandro P Comellas
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States
| | - Eric A Hoffman
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, United States
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States
- Department of Radiology, University of Iowa, Iowa City, Iowa, United States
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Pathirathna ML, Dematawewa CMB, Sekijima K, Sadakata M, Muramatsu Y, Fujiwara N. Impact of solid fuel usage on respiratory symptoms among reproductive aged women: a cross-sectional study in Sri Lanka. BMC Public Health 2022; 22:2255. [PMID: 36463153 PMCID: PMC9719257 DOI: 10.1186/s12889-022-14748-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 11/28/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Worldwide, around 3 billion people rely on solid fuel for their daily energy needs. Household air pollution secondary to solid fuel burning is a major risk factor for respiratory mobility among vulnerable populations. This study aimed to investigate the respiratory symptoms associated with solid fuel usage, the level of kitchen fuel smoke exposure and its association with respiratory symptoms among reproductive-aged women in Sri Lanka, where most households exclusively use firewood as the primary cooking fuel. METHODS A descriptive cross-sectional study was conducted among 403 reproductive-aged women (15 to 49 years) in the Central Province, Sri Lanka. A structured interviewer-administered questionnaire was used to collect data, and an exposure assessment was done using a breath carbon monoxide monitor. RESULTS After adjusting for potential confounding factors by the logistic regression models, the odds ratios (OR) of the liquid petroleum gas-only users for at least one respiratory symptom relevant to cough (OR: 0.39; 95% confidence interval [CI]: 0.20-0.78), wheezing (OR: 0.47; 95% [CI]: 0.26-0.87), and dyspnea (OR: 0.44; 95% CI: 0.24-0.84) were significantly lower compared to firewood-only users. The mean of expired air carbon monoxide and estimated carboxyhemoglobin levels of liquid petroleum gas-only users (2.84 ± 2.85 ppm; 1.08 ± 0.46%) were significantly lower than those of firewood-only users (5.27 ± 4.64 ppm; 1.47 ± 0.74%). CONCLUSIONS The use of firewood increased the risk of respiratory symptoms among reproductive-aged women in Sri Lanka. Health education focused on positive behavioral changes and effective and efficient clean energy policies are recommended to mitigate the risk associated with solid fuel smoke exposure.
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Affiliation(s)
- Malshani Lakshika Pathirathna
- grid.11139.3b0000 0000 9816 8637Department of Nursing, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, 20400 Sri Lanka
| | | | - Kayako Sekijima
- grid.260975.f0000 0001 0671 5144Graduate School of Health Sciences, Niigata University, 2-746, Asahimachi-Dori, Chuo-Ku, Niigata, 951-8518 Japan
| | - Mieko Sadakata
- grid.260975.f0000 0001 0671 5144Graduate School of Health Sciences, Niigata University, 2-746, Asahimachi-Dori, Chuo-Ku, Niigata, 951-8518 Japan
| | - Yoshiyuki Muramatsu
- grid.260975.f0000 0001 0671 5144Graduate School of Health Sciences, Niigata University, 2-746, Asahimachi-Dori, Chuo-Ku, Niigata, 951-8518 Japan
| | - Naoshi Fujiwara
- grid.260975.f0000 0001 0671 5144Graduate School of Health Sciences, Niigata University, 2-746, Asahimachi-Dori, Chuo-Ku, Niigata, 951-8518 Japan
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Qiu AY, Leng S, McCormack M, Peden DB, Sood A. Lung Effects of Household Air Pollution. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2807-2819. [PMID: 36064186 DOI: 10.1016/j.jaip.2022.08.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 06/15/2023]
Abstract
Biomass fuel smoke, secondhand smoke, and oxides of nitrogen are common causes of household air pollution (HAP). Almost 2.4 billion people worldwide use solid fuels for cooking and heating, mostly in low- and middle-income countries. Wood combustion for household heating is also common in many areas of high-income countries, and minorities are particularly vulnerable. HAP in low- and middle-income countries is associated with asthma, acute respiratory tract infections in adults and children, chronic obstructive pulmonary disease, lung cancer, tuberculosis, and respiratory mortality. Although wood smoke exposure levels in high-income countries are typically lower than in lower-income countries, it is similarly associated with accelerated lung function decline, higher prevalence of airflow obstruction and chronic bronchitis, and higher all-cause and respiratory cause-specific mortality. Household air cleaners with high-efficiency particle filters have mixed effects on asthma and chronic obstructive pulmonary disease outcomes. Biomass fuel interventions in low-income countries include adding chimneys to cookstoves, improving biomass fuel combustion stoves, and switching fuel to liquid petroleum gas. Still, the impact on health outcomes is inconsistent. In high-income countries, strategies for reducing biomass fuel-related HAP are centered on community-level woodstove changeout programs, although the results are again inconsistent. In addition, initiatives to encourage home smoking bans have mixed success in households with children. Environmental solutions to reduce HAP have varying success in reducing pollutants and health problems. Improved understanding of indoor air quality factors and actions that prevent degradation or improve polluted indoor air may lead to enhanced environmental health policies, but health outcomes must be rigorously examined.
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Affiliation(s)
- Anna Y Qiu
- Johns Hopkins University, School of Medicine, Baltimore, Md
| | - Shuguang Leng
- University of New Mexico School of Medicine, Albuquerque, NM; University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | | | - David B Peden
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Akshay Sood
- University of New Mexico School of Medicine, Albuquerque, NM; Miners Colfax Medical Center, Raton, NM.
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Kansiime WK, Mugambe RK, Atusingwize E, Wafula ST, Nsereko V, Ssekamatte T, Nalugya A, Coker ES, Ssempebwa JC, Isunju JB. Use of biomass fuels predicts indoor particulate matter and carbon monoxide concentrations; evidence from an informal urban settlement in Fort Portal city, Uganda. BMC Public Health 2022; 22:1723. [PMID: 36089579 PMCID: PMC9464485 DOI: 10.1186/s12889-022-14015-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Poor indoor air quality (IAQ) is a leading cause of respiratory and cardiopulmonary illnesses. Particulate matter (PM2.5) and carbon monoxide (CO) are critical indicators of IAQ, yet there is limited evidence of their concentrations in informal urban settlements in low-income countries.
Objective
This study assessed household characteristics that predict the concentrations of PM2.5 and CO within households in an informal settlement in Fort Portal City, Uganda.
Methodology
A cross-sectional study was conducted in 374 households. Concentrations of PM2.5 and CO were measured using a multi-purpose laser particle detector and a carbon monoxide IAQ meter, respectively. Data on household characteristics were collected using a structured questionnaire and an observational checklist. Data were analysed using STATA version 14.0. Linear regression was used to establish the relationship between PM2.5, CO concentrations and household cooking characteristics.
Results
The majority (89%, 332/374) of the households used charcoal for cooking. More than half (52%, 194/374) cooked outdoors. Cooking areas had significantly higher PM2.5 and CO concentrations (t = 18.14, p ≤ 0.05) and (t = 5.77 p ≤ 0.05), respectively. Cooking outdoors was associated with a 0.112 increase in the PM2.5 concentrations in the cooking area (0.112 [95% CI: -0.069, 1.614; p = 0.033]). Cooking with moderately polluting fuel was associated with a 0.718 increase in CO concentrations (0.718 [95% CI: 0.084, 1.352; p = 0.027]) in the living area.
Conclusions
The cooking and the living areas had high concentrations of PM2.5 and CO during the cooking time. Cooking with charcoal resulted in higher CO in the living area. Furthermore, cooking outdoors did not have a protective effect against PM2.5, and ambient PM2.5 exceeded the WHO Air quality limits. Interventions to improve the indoor air quality in informal settlements should promote a switch to cleaner cooking energy and improvement in the ambient air quality.
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Wang Y, Shupler M, Birch A, Chu YL, Jeronimo M, Rangarajan S, Mustaha M, Heenan L, Seron P, Saavedra N, Oliveros MJ, Lopez-Jaramillo P, Camacho PA, Otero J, Perez-Mayorga M, Yeates K, West N, Ncube T, Ncube B, Chifamba J, Yusuf R, Khan A, Liu Z, Cheng X, Wei L, Tse LA, Mohan D, Kumar P, Gupta R, Mohan I, Jayachitra KG, Mony PK, Rammohan K, Nair S, Lakshmi PVM, Sagar V, Khawaja R, Iqbal R, Kazmi K, Yusuf S, Brauer M, Hystad P. Personal and household PM 2.5 and black carbon exposure measures and respiratory symptoms in 8 low- and middle-income countries. ENVIRONMENTAL RESEARCH 2022; 212:113430. [PMID: 35526584 DOI: 10.1016/j.envres.2022.113430] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 04/22/2022] [Accepted: 05/02/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Household air pollution (HAP) from cooking with solid fuels has been associated with adverse respiratory effects, but most studies use surveys of fuel use to define HAP exposure, rather than on actual air pollution exposure measurements. OBJECTIVE To examine associations between household and personal fine particulate matter (PM2.5) and black carbon (BC) measures and respiratory symptoms. METHODS As part of the Prospective Urban and Rural Epidemiology Air Pollution study, we analyzed 48-h household and personal PM2.5 and BC measurements for 870 individuals using different cooking fuels from 62 communities in 8 countries (Bangladesh, Chile, China, Colombia, India, Pakistan, Tanzania, and Zimbabwe). Self-reported respiratory symptoms were collected after monitoring. Associations between PM2.5 and BC exposures and respiratory symptoms were examined using logistic regression models, controlling for individual, household, and community covariates. RESULTS The median (interquartile range) of household and personal PM2.5 was 73.5 (119.1) and 65.3 (91.5) μg/m3, and for household and personal BC was 3.4 (8.3) and 2.5 (4.9) x10-5 m-1, respectively. We observed associations between household PM2.5 and wheeze (OR: 1.25; 95%CI: 1.07, 1.46), cough (OR: 1.22; 95%CI: 1.06, 1.39), and sputum (OR: 1.26; 95%CI: 1.10, 1.44), as well as exposure to household BC and wheeze (OR: 1.20; 95%CI: 1.03, 1.39) and sputum (OR: 1.20; 95%CI: 1.05, 1.36), per IQR increase. We observed associations between personal PM2.5 and wheeze (OR: 1.23; 95%CI: 1.00, 1.50) and sputum (OR: 1.19; 95%CI: 1.00, 1.41). For household PM2.5 and BC, associations were generally stronger for females compared to males. Models using an indicator variable of solid versus clean fuels resulted in larger OR estimates with less precision. CONCLUSIONS We used measurements of household and personal air pollution for individuals using different cooking fuels and documented strong associations with respiratory symptoms.
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Affiliation(s)
- Ying Wang
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| | - Matthew Shupler
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Aaron Birch
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yen Li Chu
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthew Jeronimo
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Maha Mustaha
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Laura Heenan
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | - Paul A Camacho
- Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Colombia
| | - Johnna Otero
- Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Colombia
| | | | - Karen Yeates
- Pamoja Tunaweza Research Centre, Moshi, Tanzania; Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Nicola West
- Pamoja Tunaweza Research Centre, Moshi, Tanzania
| | - Tatenda Ncube
- Department of Biomedical Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Brian Ncube
- Department of Biomedical Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Jephat Chifamba
- Department of Biomedical Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Rita Yusuf
- School of Life Sciences, Independent University, Dhaka, Bangladesh
| | - Afreen Khan
- School of Life Sciences, Independent University, Dhaka, Bangladesh
| | - Zhiguang Liu
- Beijing An Zhen Hospital of the Capital University of Medical Sciences, China
| | - Xiaoru Cheng
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, China
| | - Li Wei
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, China
| | - L A Tse
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, HKSAR, China
| | - Deepa Mohan
- Madras Diabetes Research Foundation, Chennai, India
| | | | - Rajeev Gupta
- Eternal Heart Care Centre & Research Institute, Jaipur, India
| | - Indu Mohan
- Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, India
| | - K G Jayachitra
- St. John's Medical College & Research Institute, Bangalore, India
| | - Prem K Mony
- St. John's Medical College & Research Institute, Bangalore, India
| | - Kamala Rammohan
- Health Action By People, Government Medical College, Trivandrum, India
| | - Sanjeev Nair
- Health Action By People, Government Medical College, Trivandrum, India
| | - P V M Lakshmi
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivek Sagar
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rehman Khawaja
- Department of Community Health Science, Aga Khan University Hospital, Karachi, Pakistan
| | - Romaina Iqbal
- Department of Community Health Science, Aga Khan University Hospital, Karachi, Pakistan
| | - Khawar Kazmi
- Department of Community Health Science, Aga Khan University Hospital, Karachi, Pakistan
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Michael Brauer
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States.
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9
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Chowdhury M, Ghosh S, Padhy PK. Effects of indoor air pollution on tribal community in rural India and health risk assessment due to domestic biomass burning: a realistic approach using the lung deposition model. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:59606-59618. [PMID: 35391641 DOI: 10.1007/s11356-022-19973-7] [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: 02/18/2022] [Accepted: 03/25/2022] [Indexed: 06/14/2023]
Abstract
Indoor air pollution from the combustion of biomass fuel and associated health risks is a critical issue in developing countries. Concentrations of PM2.5 and PM10 are measured in Birbhum, West Bengal, during 2017-2018. PM2.5-bound elemental concentrations of twelve metals are determined in rural kitchens. The results showed higher toxicological risks in BMF (1.15) than the LPG users (0.14). The risk of non-carcinogenic exposure related with dermal contact and ingestion was observed in the acceptable limits (HQ < 1) for all age groups, and the risk associated with inhalation exposure from Cr, Ni, As, and Mn exceeded the acceptable limit. Results also suggest that carcinogenic risks from ingestion and dermal contact are within the acceptable limit (1 × 10-4-1 × 10-6) except Cr and As which were found to exceed the range. The deposition flux (Dφ) for multiple metals in the head airway region, tracheobronchial region, and alveolar regions was found to be higher in teenagers as compared to other groups, whereas the value was lower in infants. Further, it was notified from the Dφ that the metals could pass through the head airways and harm the tracheobronchial tree and alveolar region, increasing the risk of human health.
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Affiliation(s)
- Mallika Chowdhury
- Department of Environmental Studies, Institute of Science (Siksha Bhavana), Visva-Bharati, Santiniketan, - 731235, West Bengal, India
| | - Suraj Ghosh
- Department of Environmental Studies, Institute of Science (Siksha Bhavana), Visva-Bharati, Santiniketan, - 731235, West Bengal, India
| | - Pratap Kumar Padhy
- Department of Environmental Studies, Institute of Science (Siksha Bhavana), Visva-Bharati, Santiniketan, - 731235, West Bengal, India.
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10
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Zoller T, Mfinanga EH, Zumba TB, Asilia PJ, Mutabazi EM, Wimmersberger D, Mhimbira F, Haraka F, Reither K. Symptoms and functional limitations related to respiratory health and carbon monoxide poisoning in Tanzania: a cross sectional study. Environ Health 2022; 21:38. [PMID: 35365149 PMCID: PMC8976359 DOI: 10.1186/s12940-022-00847-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 03/10/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The burden of chronic respiratory symptoms and respiratory functional limitations is underestimated in Africa. Few data are available on carbon monoxide (CO) poisoning in sub-Saharan Africa and existing data is derived from CO in ambient air, but not from biomarkers in the blood. METHODS Data from the Tanzanian Lung Health study, a cross-sectional study on lung health among outpatients and visitors to an urban as well as a rural hospital in Tanzania, was analyzed to describe respiratory symptoms and functional limitations. Saturation of peripheral blood with carbon monoxide (SpCO) was measured transcutaneously and non-invasively in participants using a modified pulse oxymeter indicative of CO poisoning. Univariate and multivariate analysis was performed. RESULTS Nine hundred and ninety-seven participants were included in the analysis, the median age of participants was 46 years (49% male). 38% of participants reported some degree of chronic shortness of breath and 26% felt limited in their daily activities or at work by this symptom. The median SpCO was 7% (IQR 4-13, range 2-31%) among all participants without active smoking status (N = 808). Participants cooking with gas or electricity had the lowest SpCO (median 5%), followed by participants cooking with charcoal (median 7%). Cooking with wood, particularly using a stove, resulted in highest SpCO (median 11.5%). Participants from households where cooking takes place in a separate room had the lowest SpCO as compared to cooking outside or cooking in a shared room inside (6% vs. 9% vs.10.5%, p < 0.01). Sex or the activity of cooking itself was not associated with a difference in SpCO. Multivariate analysis confirmed cooking in a separate room (as compared to cooking outside) and living in a rural vs. urban setting as protective factors against high SpCO. CONCLUSION The findings demonstrate a high burden of chronic respiratory symptoms which also cause socioeconomic impact. High levels of SpCO indicate a relevant burden of carbon monoxide poisoning in the local population. The level of CO in the blood is more dependent on shared exposure to sources of CO with the type of housing and type of cooking fuel as most relevant factors, and less on person-individual risk factors or activities.
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Affiliation(s)
- Thomas Zoller
- Swiss Tropical and Public Health Institute, Socinstr. 57, 4051, Basel, Switzerland
- Ifakara Health Institute, Dar es Salaam, Tanzania
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- University of Basel, Basel, Switzerland
| | | | | | | | | | - David Wimmersberger
- Swiss Tropical and Public Health Institute, Socinstr. 57, 4051, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Frederick Haraka
- Swiss Tropical and Public Health Institute, Socinstr. 57, 4051, Basel, Switzerland
- Ifakara Health Institute, Dar es Salaam, Tanzania
- University of Basel, Basel, Switzerland
| | - Klaus Reither
- Swiss Tropical and Public Health Institute, Socinstr. 57, 4051, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
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11
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Mortimer K, Montes de Oca M, Salvi S, Balakrishnan K, Hadfield RM, Ramirez-Venegas A, Halpin DMG, Ozoh Obianuju B, Han MeiLan K, Perez Padilla R, Kirenga B, Balmes JR. Household air pollution and COPD: cause and effect or confounding by other aspects of poverty? Int J Tuberc Lung Dis 2022; 26:206-216. [PMID: 35197160 PMCID: PMC8886958 DOI: 10.5588/ijtld.21.0570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
SETTING : Household air pollution (HAP) and chronic obstructive pulmonary disease (COPD) are both major public health problems, reported to cause around 4 million and 3 million deaths every year, respectively. The great majority of these deaths, as well as the burden of disease during life is felt by people in low- and middle-income countries (LMICs). OBJECTIVE AND DESIGN : The extent to which HAP causes COPD is controversial; we therefore undertook this review to offer a viewpoint on this from the Global Initiative for COPD (GOLD). RESULTS : We find that while COPD is well-defined in many studies on COPD and HAP, there are major limitations to the definition and measurement of HAP. It is thus difficult to disentangle HAP from other features of poverty that are themselves associated with COPD. We identify other limitations to primary research studies, including the use of cross-sectional designs that limit causal inference. CONCLUSION : There is substantial preventable morbidity and mortality associated with HAP, COPD and poverty, separately and together. Although it may not be possible to define clear causal links between HAP and COPD, there is a clear urgency to reduce the avoidable burden of disease these inflict on the world’s poor.
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Affiliation(s)
- K Mortimer
- University of Cambridge, Cambridge, UK, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - M Montes de Oca
- Hospital Universitario de Caracas Universidad Central de Venezuela and Centro Médico de Caracas, Caracas, Venezuela
| | - S Salvi
- Pulmocare Research and Education (PURE) Foundation, Pune, India
| | | | - R M Hadfield
- Australian Institute for Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - A Ramirez-Venegas
- Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias, Mexico
| | - D M G Halpin
- College of Medicine and Health, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - B Ozoh Obianuju
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | - R Perez Padilla
- Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias, Mexico
| | - B Kirenga
- Makerere University Lung Institute, Kampala, Uganda
| | - J R Balmes
- Department of Medicine, University of California, San Francisco and Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
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12
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Estimating long-term average household air pollution concentrations from repeated short-term measurements in the presence of seasonal trends and crossover. Environ Epidemiol 2022; 6:e188. [PMID: 35169666 PMCID: PMC8835562 DOI: 10.1097/ee9.0000000000000188] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/26/2021] [Indexed: 11/26/2022] Open
Abstract
Estimating long-term exposure to household air pollution is essential for quantifying health effects of chronic exposure and the benefits of intervention strategies. However, typically only a small number of short-term measurements are made. We compare different statistical models for combining these short-term measurements into predictions of a long-term average, with emphasis on the impact of temporal trends in concentrations and crossover in study design. We demonstrate that a linear mixed model that includes time adjustment provides the best predictions of long-term average, which have lower error than using household averages or mixed models without time, for a variety of different study designs and underlying temporal trends. In a case study of a cookstove intervention study in Honduras, we further demonstrate how, in the presence of strong seasonal variation, long-term average predictions from the mixed model approach based on only two or three measurements can have less error than predictions based on an average of up to six measurements. These results have important implications for the efficiency of designs and analyses in studies assessing the chronic health impacts of long-term exposure to household air pollution.
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13
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Lim YH, Hersoug LG, Lund R, Bruunsgaard H, Ketzel M, Brandt J, Jørgensen JT, Westendorp R, Andersen ZJ, Loft S. Inflammatory markers and lung function in relation to indoor and ambient air pollution. Int J Hyg Environ Health 2022; 241:113944. [PMID: 35176573 DOI: 10.1016/j.ijheh.2022.113944] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/04/2022] [Accepted: 02/09/2022] [Indexed: 12/16/2022]
Abstract
Ambient air pollution causes a range of adverse health effects, whereas effects of indoor sources of air pollution are not well described in high-income countries. We compared hazards of ambient air pollution and indoor sources with respect to important biomarkers of cardiorespiratory effects in terms of lung function and systemic inflammation in a middle-aged Danish cohort. Our cohort comprised 5199 men and women aged 49-63 years at the recruitment during April 2009 to March 2011, with information on exposure to second-hand smoke (SHS) and use of candles, wood stove, kerosene heater and gas cooker as well as relevant covariates. Ambient air pollution exposure was assessed as 2-year mean nitrogen dioxide (NO2) at the address (mean ± SD: 17.1 ± 9.9 μg/m3) and 4-day average levels of particulate matter with diameter <2.5 μm (PM2.5; mean ± SD: 12.5 ± 6.0 μg/m3) in urban background. Lung function was assessed as % predicted forced expiratory volume in the first second (FEV1) and inflammatory markers comprised interleukin-6 (IL-6), IL-10, IL-18, interferon gamma (IFN-γ), tumor necrosis factor alpha (TNF-α), and high sensitivity C-reactive protein (hs-CRP). We used random-effect regression models controlling for potential confounders as well as models with further adjustment for self-reported health or for all other exposures. In models adjusted for confounders FEV1 was inversely associated with exposure to NO2, (-0,83% per 10 μg/m3; 95% CI: -1.26; -0.41%), SHS (-0.56% per 1 of 5 categories increment; 95% CI: -0.89; -0.23%), and gas cooker without hood (-0.89%; 95% CI: -1.62; -0.17%), whereas use of wood stove and candles showed positive associations, although these attenuated by mutual adjustment for all exposures or self-reported health. IL-6 showed positive associations with NO2 (6.30% increase in log-transformed values per 10 μg/m3; 95% CI: 3.54; 9.05%), PM2.5 (7.82% per 10 μg/m3; 95% CI: 3.35; 12.4%), SHS (4.38% per increase of 1 of 5 categories; 95% CI: 2.22; 6.54%) and use of kerosene (13.8%; 95% CI: 2.51; 25.1%), whereas the associations with use of wood stove and candles were inverse. PM2.5 and NO2 showed positive associations with IFN-γ and TNF-α, while PM2.5 further associated with IL-10 and IL-18. Hs-CRP was inversely associated with use of candles. These results suggest that the levels of exposure to ambient air pollution and SHS are more harmful than are the levels of exposure to indoor combustion sources from candles and wood stoves in a high-income setting.
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Affiliation(s)
- Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lars-Georg Hersoug
- Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rikke Lund
- Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Helle Bruunsgaard
- Department of Clinical Immunology 7631, Rigshospitalet, University Hospital of Copenhagen, Copenhagen and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; Global Centre for Clean Air Research (GCARE), University of Surrey, United Kingdom
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; iClimate - interdisciplinary Centre for Climate Change, Aarhus University, Roskilde, Denmark
| | - Jeanette Therming Jørgensen
- Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rudi Westendorp
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark; Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Zorana Jovanovic Andersen
- Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Loft
- Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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14
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Long H, Xing Z, Chai D, Liu W, Tong Y, Wang Y, Ma Y, Pan M, Cui J, Guo Y. Solid Fuel Exposure and Chronic Obstructive Pulmonary Disease in Never-Smokers. Front Med (Lausanne) 2022; 8:757333. [PMID: 35004725 PMCID: PMC8727436 DOI: 10.3389/fmed.2021.757333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/25/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is a public health challenge globally. The burden of COPD is high in never-smokers but little is known about its causes. We aimed to find the prevalence and correlates of COPD in never-smokers, with a special focus on solid fuel exposure. Methods: We conducted a cross-sectional study in Western China. COPD was defined by FEV1/FVC < lower limits of normal (LLN). Descriptive statistics and multivariable logistic regression were used for analyses. Results: Six thousand two hundred and seventy one patients were enrolled between June 2015 and August 2016. The prevalence of COPD in never-smokers was 15.0% (95% confidence interval 14.1–15.9). The common independent predictors of COPD in never-smokers included age ≥60 years, exposure to solid fuel, living in a rural area and a history of tuberculosis. Participants with solid fuel exposure were 69% more likely to have COPD (adjusted odds ratio 1.69, 95% CI 1.41–2.04) than those without such exposure. In addition, we found a positive association between small airway dysfunction and solid fuel exposure (OR 1.35, 95% CI 1.18–1.53). Conclusions: This study confirmed the substantial burden of COPD among never-smokers and also defined the risk factors for COPD in never-smokers. Furthermore, we found a positive association between solid fuel exposure and COPD or small airway dysfunction.
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Affiliation(s)
- HuanYu Long
- Department of Respiratory and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - ZhenZhen Xing
- Department of Respiratory and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Di Chai
- Department of Respiratory and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - WeiMing Liu
- Department of Intensive Care Medicine, Beijing Boai Hospital, Beijing, China.,Rehabilitation Research Center, Beijing, China
| | - YaQi Tong
- Department of Respiratory and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - YuXia Wang
- Department of Respiratory and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - YaLi Ma
- Department of Respiratory and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - MingMing Pan
- Department of Respiratory and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jia Cui
- Department of Respiratory and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - YanFei Guo
- Department of Respiratory and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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15
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Martinez-Soto A, Avendaño Vera CC, Boso A, Hofflinger A, Shupler M. Energy poverty influences urban outdoor air pollution levels during COVID-19 lockdown in south-central Chile. ENERGY POLICY 2021; 158:112571. [PMID: 34511701 PMCID: PMC8418915 DOI: 10.1016/j.enpol.2021.112571] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/19/2021] [Accepted: 08/31/2021] [Indexed: 06/13/2023]
Abstract
The effect of COVID-19 lockdowns on ambient air pollution levels in urban south-central Chile, where outdoor air pollution primarily originates indoors from wood burning for heating, may differ from trends in cities where transportation and industrial emission sources dominate. This quasi-experimental study compared hourly fine (PM2.5) and coarse (PM10) particulate matter measurements from six air monitors (three beta attenuation monitors; three low-cost sensors) in commercial and low/middle-income residential areas of Temuco, Chile between 2019 and 2020. The potential impact of varying annual meterological conditions on air quality was also assessed. During COVID-19 lockdown, average monthly ambient PM2.5 concentrations in a commercial and middle-income residential neighborhood of Temuco were up to 50% higher (from 12 to 18 μg/m3) and 59% higher (from 22 to 35 μg/m3) than 2019 levels, respectively. Conversely, PM2.5 levels decreased by up to 52% (from 43 to 21 μg/m3) in low-income areas. The fine fraction of PM10 in April 2020 was 48% higher than in April 2017-2019 (from 50% to 74%) in a commercial area. These changes did not appear to result from meterological differences between years. During COVID-19 lockdown, higher outdoor PM2.5 pollution from wood heating existed in more affluent areas of Temuco, while PM2.5 concentrations declined among poorer households refraining from wood heating. To reduce air pollution and energy poverty in south-central Chile, affordability of clean heating fuels (e.g. electricity) should be a policy priority.
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Affiliation(s)
- Aner Martinez-Soto
- Department of Civil Engineering, Faculty of Engineering and Science, Universidad de La Frontera, Temuco, Chile
| | - Constanza C Avendaño Vera
- Department of Civil Engineering, Faculty of Engineering and Science, Universidad de La Frontera, Temuco, Chile
| | - Alex Boso
- Núcleo en Ciencias Sociales y Humanidades, Butamallín Research Center for Global Change, Universidad de La Frontera, Temuco, Chile
| | - Alvaro Hofflinger
- Núcleo en Ciencias Sociales y Humanidades, Butamallín Research Center for Global Change, Universidad de La Frontera, Temuco, Chile
| | - Matthew Shupler
- Department of Public Health, Policy and Systems, University of Liverpool, UK
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16
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Zhang J, Perret JL, Chang AB, Idrose NS, Bui DS, Lowe AJ, Abramson MJ, Walters EH, Lodge CJ, Dharmage SC. Risk factors for chronic cough in adults: A systematic review and meta-analysis. Respirology 2021; 27:36-47. [PMID: 34658107 DOI: 10.1111/resp.14169] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/05/2021] [Accepted: 09/22/2021] [Indexed: 12/14/2022]
Abstract
Despite the challenges of diagnosing and managing adult patients with chronic cough, a systematic synthesis of evidence on aetiological risk factor is lacking. We systematically searched PubMed and EMBASE to synthesize the current evidence for longitudinal associations between a wide range of risk factors and chronic cough in the general adult population, following the meta-analysis of observational studies in epidemiology (MOOSE) guidelines. The Newcastle-Ottawa scale was used to assess the quality of the included studies. Fixed-effect meta-analysis was conducted where appropriate. Of 26 eligible articles, 16 domains of risk factors were assessed. There was consistent evidence that asthma (pooled adjusted OR [aOR] = 3.01; 95% CI: 2.33-3.70; I2 = 0%; number of articles [N] = 3) and low education levels/socioeconomic status (SES) (pooled aOR = 1.46; 95% CI: 1.20-1.72; I2 = 0%; N = 3) were associated with an increased risk of chronic cough after adjusting for smoking and other confounders. While continuous smoking was associated with chronic cough (aOR = 1.81; 95% CI: 1.36-2.26; I2 = 57%; N = 3), there was too little evidence to draw conclusions for occupational exposures, outdoor air pollution, early-life exposures, diet, snoring and other chronic conditions, including obesity, chronic obstructive pulmonary disease, gastro-oesophageal reflux disease and chronic pain. Asthma, persistent smoking and lower education/SES were associated with an increased risk of chronic cough. Longitudinal associations between other factors frequently mentioned empirically (i.e., occupational exposures, air pollution and chronic respiratory conditions) need further investigation, ideally with objective and standardized measurement.
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Affiliation(s)
- Jingwen Zhang
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jennifer L Perret
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Child Health Division, Menzies School of Health Research, Hobart, Northwest Territories, Australia
| | - Nur S Idrose
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dinh S Bui
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Adrian J Lowe
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - E Haydn Walters
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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17
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Piracón JAB, Vallejo LAM, Cortés MAQ, Vasquez YA, Achury NJM, Cerón LCB, Hernández MA. Spirometry parameter alterations due to exposure to indoor air pollutants in rural homes in Bogotá, Colombia. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:57275-57287. [PMID: 34086176 DOI: 10.1007/s11356-021-14717-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/31/2021] [Indexed: 06/12/2023]
Abstract
The aim of this study was to determine the association between the concentrations of intradomiciliary PM2.5, CO, and BC and alterations in respiratory function parameters in a population living in rural dwellings in Bogotá, Colombia. For this cross-sectional study, people were recruited from the rural areas of the localities of Usme and Sumapaz in Bogotá. In total, 68 participants were recruited by means of nonrandom sampling. Indoor air monitoring of PM2.5, BC, and CO was carried out. Additionally, evaluations of pulmonary function were performed using spirometry. The variables of pulmonary function were included in a multiple linear regression by successive steps and adjusted by the main variables described as modifiers of spirometry parameters, which are age, height, sex, disability, and a history of tobacco use. Assumptions of multicollinearity and the randomization of variances in the residuals were evaluated. Negative associations were found between spirometry parameters and the concentrations of indoor air pollutants. For FEV1/FVC and theoretical FEV1, there was a statistically significant association with the concentration of carbon monoxide (p = 0.003 and 0.019, respectively). The environmental concentrations were higher in homes where biomass was used for cooking, but these differences were statistically significant only for BC and CO (p = 0.008 and 0.03, respectively). The concentrations of carbon monoxide in rural homes were associated with alterations in respiratory function parameters.
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18
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Kaali S, Jack D, Lee AG. The Conundrum of Cleaner Cookstove Interventions: Necessary but Insufficient? Am J Respir Crit Care Med 2021; 203:1336-1338. [PMID: 33357118 PMCID: PMC8456526 DOI: 10.1164/rccm.202012-4353ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Seyram Kaali
- Kintampo Health Research Centre Ghana Health Service Kintampo, Ghana
| | - Darby Jack
- Department of Environmental Health Sciences Columbia University Mailman School of Public Health New York, New York
| | - 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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Ravindra K, Kaur-Sidhu M, Mor S. Transition to clean household energy through an application of integrated model: Ensuring sustainability for better health, climate and environment. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 775:145657. [PMID: 33621873 DOI: 10.1016/j.scitotenv.2021.145657] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 06/12/2023]
Abstract
Sustained use and adoption of clean cooking fuels have become an important concern for developing countries due to the enormous burden of diseases attributable to household air pollution (HAP). The transition and adoption of clean household energy involve various socio-economic, behavioral, and technological barriers at different community levels. Hence, the present paper aims to scrutinize the factors, key determinants, and other interventions among rural households that limit clean cookstoves' sustained uses. The study proposes an integrated model to enhance clean cooking fuel uptake and uses based on the available evidence. The health, climate and environmental factors were identified as the key to trigger the adoption of clean cooking fuel alternatives. The model comprises the integration of components for targeted clean fuel policy interventions and promotes green recovery. The elements include Knowledge, Housing characteristics, Awareness, Interventions, Willingness to pay, Adoption, Lower emissions and Gender Equality (THE KHAIWAL model) to ascertain the intervention focus regions. Integration of model components in policy implementation will promote clean household energy to reduce emissions, leading to improve quality of life, good health, women empowerment, better air quality and climate.
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Affiliation(s)
- Khaiwal Ravindra
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.
| | - Maninder Kaur-Sidhu
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Suman Mor
- Department of Environment Studies, Panjab University, Chandigarh 160014, India
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Sex and Gender Differences in Lung Disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1304:227-258. [PMID: 34019273 DOI: 10.1007/978-3-030-68748-9_14] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Sex differences in the anatomy and physiology of the respiratory system have been widely reported. These intrinsic sex differences have also been shown to modulate the pathophysiology, incidence, morbidity, and mortality of several lung diseases across the life span. In this chapter, we describe the epidemiology of sex differences in respiratory diseases including neonatal lung disease (respiratory distress syndrome, bronchopulmonary dysplasia) and pediatric and adult disease (including asthma, cystic fibrosis, idiopathic pulmonary fibrosis, chronic obstructive pulmonary disease, lung cancer, lymphangioleiomyomatosis, obstructive sleep apnea, pulmonary arterial hypertension, and respiratory viral infections such as respiratory syncytial virus, influenza, and SARS-CoV-2). We also discuss the current state of research on the mechanisms underlying the observed sex differences in lung disease susceptibility and severity and the importance of considering both sex and gender variables in research studies' design and analysis.
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Rao SR, Chitra GA, Elavarasu G, Kamaraj P, Kaliaperumal K, Kaur P. Exposure to mosquito coil and biomass fuel smoke and respiratory health in rural Tamil Nadu, India. J Public Health (Oxf) 2021; 44:625-633. [PMID: 33912972 DOI: 10.1093/pubmed/fdab119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 03/11/2021] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mosquito coil smoke, along with biomass fuel smoke, are sources of indoor air pollution. Biomass fuel smoke has been studied as a risk factor for poor respiratory outcomes. However, in an Indian context, few studies examine the effect of mosquito coil exposure on poor respiratory outcomes at the community level. OBJECTIVES To estimate the prevalence of the biomass fuel and mosquito coil use and to determine the association between the use of bio-mass fuel and mosquito coil and poor respiratory health. METHODS A cross-sectional survey of 4662 individuals (above the age of 30 years) was conducted using a pre-tested questionnaire. Trained interviewers collected data on current and past use of biomass fuels and mosquito coils, usage practices and respiratory health. We computed proportions for exposure variables namely biomass fuel, mosquito coil use and other covariates. We conducted univariate analysis, followed by multivariate logistic regression. RESULTS The prevalence of ever use of biomass fuels was high (wood: 97.9%; cow dung cake: 76.0% and crop residue: 54.4%). Current use of wood, cow dung cake and crop residue was prevalent among 75.7, 24.3 and 30.9% respondents, respectively. Almost 70% of respondents had ever used mosquito coils, whereas 54% were current users. Overall, 5.5% respondents had poor respiratory health either due to chronic bronchitis or asthma. In multivariate analysis, use of combination of all three biomass fuel types (adjusted odds ratio [AOR] 1.69, 95% confidence interval [CI]: 1.13-2.54) and use of mosquito coil more than or equal to 5 days per week (AOR 1.43, 95% CI: 1.04-1.99) were associated with poor respiratory health after adjusting for covariates age, gender, smoking, kitchen type and for each other. CONCLUSIONS Use of biomass fuels and mosquito coils was high in the study population and was associated with poor respiratory health. Therefore, mosquito coil smoke should also be considered an important source of indoor air pollution, similar to biomass fuel exposure. Community education about these sources of indoor air pollution and increased coverage of cleaner fuels and alternative mosquito control methods should be the way forward in the rural areas.
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Affiliation(s)
- Sudha Ramachandra Rao
- National Institute of Epidemiology, Division of Non Communicable Diseases, Chennai, Tamil Nadu 600 077, India
| | - Grace A Chitra
- Department of Epidemiology, Global Institute of Public Health, Ananthapuri Hospitals and Research Institute, Chacka, Thiruvananthapuram, Kerala 695024, India
| | - G Elavarasu
- National Institute of Epidemiology, Division of Non Communicable Diseases, Chennai, Tamil Nadu 600 077, India
| | - P Kamaraj
- National Institute of Epidemiology, Division of Non Communicable Diseases, Chennai, Tamil Nadu 600 077, India
| | - Kanagasabai Kaliaperumal
- National Institute of Epidemiology, Division of Non Communicable Diseases, Chennai, Tamil Nadu 600 077, India
| | - Prabhdeep Kaur
- National Institute of Epidemiology, Division of Non Communicable Diseases, Chennai, Tamil Nadu 600 077, India
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Urrutia-Pereira M, Chong-Neto H, Mocellin LP, Ellwood P, Garcia-Marcos L, Simon L, Rinelli P, Solé D. Prevalence of asthma symptoms and associated factors in adolescents and adults in southern Brazil: A Global Asthma Network Phase I study. World Allergy Organ J 2021; 14:100529. [PMID: 33850603 PMCID: PMC8010518 DOI: 10.1016/j.waojou.2021.100529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/02/2021] [Accepted: 02/14/2021] [Indexed: 12/22/2022] Open
Abstract
Background The Global Asthma Network (GAN) aims to find out the current status of the prevalence and severity of asthma, rhinitis, and eczema using global surveillance to achieve worldwide recognition and improve the management of asthma, especially in low- and middle-income countries. The aim of this study was to verify the associated factors for asthma in adolescents and their respective parents/caregivers. Methods Adolescents (13–14 years old; n = 1058) and their respective parents/caregivers (mean age = 42.1 years, n = 896) living in the town of Uruguaiana, Southern Brazil fulfilled the standardized questionnaire. Results Although the prevalence of wheezing in the past 12 months was higher among adults than adolescents (18.4% vs. 15.8%, respectively), adolescents showed more severe wheezing and worse control over the disease revealed by higher consumption of short-acting beta-2 agonists; going to the emergency room; hospitalization in the last year and dry night cough. Smoking and paracetamol use were associated with risk for developing asthma symptoms and consuming seafood/fish was protective. For the adults smoking (10 or more cigarettes/day) and exposure to mould in the house were associated with risk for asthma symptoms. Conclusions Adolescents have a high prevalence of asthma symptoms and few have an action plan. Adults do not have their disease under control and they use more relief than preventive medication. Differences in associated factors could determine the outcomes in asthma control among adolescents and their parents.
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Affiliation(s)
| | | | - Lucas Pitrez Mocellin
- Department of Collective Health, Faculty of Medicine, Federal University of Pampa, Brazil
| | - Philippa Ellwood
- Department of Paediatrics: Child and Youth Health, The University of Auckland, New Zealand
| | - Luis Garcia-Marcos
- Pediatric Allergy and Pulmonology Units, Arrixaca University Children's Hospital, University of Murcia, IMIB Bio-health Research Institute of Murcia (IMIB), ARADyAL Network, Spain
| | - Laura Simon
- Department of Pediatrics, Federal University of Pampa (Unipampa), Brazil
| | - Pietro Rinelli
- Department of Pediatrics, Federal University of Pampa (Unipampa), Brazil
| | - Dirceu Solé
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, Brazil
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Huy LN, Oanh NTK, Phuc NH, Nhung CP. Survey-based inventory for atmospheric emissions from residential combustion in Vietnam. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:10678-10695. [PMID: 33099731 DOI: 10.1007/s11356-020-11067-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/30/2020] [Indexed: 06/11/2023]
Abstract
Local questionnaire surveys were conducted to collect representative activity data for calculation of annual emissions from residential combustion in Red River Delta (RRD), Vietnam, for 2010-2015. Multistage statistical sampling was implemented in the surveys for Hanoi Metropolitan Region (HMR) and deep rural area of Ninh Binh province (Con Thoi, Ninh Binh (CTNB)). Emission factors were scrutinized to select relevant ranges and central values for typical cookstoves in RRD. Large differences in the activity data (cooking activities, fuel-stove types, and fuel consumption) were found between three HMR strata (urban, suburban, and rural populations) and CTNB, respectively, which resulted in distinctly different annual emissions per capita. Annual 2010 emissions from residential combustion in RRD were estimated for toxic pollutants, in Gg/year, of 217 for CO, 1.5 NOx, 7.4 SO2, 33 NMVOC, 3.7 NH3, 16.9 PM2.5, 1.4 BC, and 7.1 OC, along with 171 t/year of total PAHs with 0.7 t/year of BaP, and greenhouse gases of 5395 CO2, 17.2 CH4, and 0.7 N2O Gg/year. Emissions increased by 1.5-7.8%, varying with species, over the 6-year period. Prevalent use of crop residue in CTNB induced its dominant shares in the residential combustion emissions not only in this deep rural area but also in the entire RRD domain. Spatial emission distribution exhibited high intensities over districts having high rural population density. Global warming potential results indicated the dominant role of black carbon, especially over the 20-year horizon. Switching from solid fuels to liquefied petroleum gas would reduce the emissions from this sector and bring in multiple benefits.
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Affiliation(s)
- Lai Nguyen Huy
- Air Pollution Research Group, Ton Duc Thang University, Ho Chi Minh City, Vietnam
- Faculty of Environment and Labour Safety, Ton Duc Thang University, Ho Chi Minh City, Vietnam
- Environmental Engineering and Management, Asian Institute of Technology, Pathumthani, Thailand
| | - Nguyen Thi Kim Oanh
- Air Pollution Research Group, Ton Duc Thang University, Ho Chi Minh City, Vietnam.
- Faculty of Environment and Labour Safety, Ton Duc Thang University, Ho Chi Minh City, Vietnam.
| | - Nguyen Hong Phuc
- Air Pollution Research Group, Ton Duc Thang University, Ho Chi Minh City, Vietnam
- Faculty of Environment and Labour Safety, Ton Duc Thang University, Ho Chi Minh City, Vietnam
- Environmental Engineering and Management, Asian Institute of Technology, Pathumthani, Thailand
| | - Chu Phuong Nhung
- Environmental Engineering and Management, Asian Institute of Technology, Pathumthani, Thailand
- Faculty of Civil Engineering, University of Transport Technology, Hanoi, Vietnam
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Woolley KE, Dickinson-Craig E, Bartington SE, Oludotun T, Kirenga B, Mariga ST, Kabera T, Coombe A, Pope FD, Singh A, Avis WR, Day R, Warburton D, Manaseki-Holland S, Moore DJ, Thomas GN. Effectiveness of interventions to reduce household air pollution from solid biomass fuels and improve maternal and child health outcomes in low- and middle-income countries: a systematic review protocol. Syst Rev 2021; 10:33. [PMID: 33472668 PMCID: PMC7818907 DOI: 10.1186/s13643-021-01590-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 01/11/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND A variety of public health interventions have been undertaken in low- and middle-income countries (LMICs) to prevent morbidity and mortality associated with household air pollution (HAP) due to cooking, heating and lighting with solid biomass fuels. Pregnant women and children under five are particularly vulnerable to the effects of HAP, due to biological susceptibility and typically higher exposure levels. However, the relative health benefits of interventions to reduce HAP exposure among these groups remain unclear. This systematic review aims to assess, among pregnant women, infants and children (under 5 years) in LMIC settings, the effectiveness of interventions which aim to reduce household air pollutant emissions due to household solid biomass fuel combustion, compared to usual cooking practices, in terms of health outcomes associated with HAP exposure. METHODS This protocol follows standard systematic review processes and abides by the PRISMA-P reporting guidelines. Searches will be undertaken in MEDLINE, EMBASE, CENTRAL, WHO International Clinical Trials Registry Platform (ICTRP), The Global Index Medicus (GIM), ClinicalTrials.gov and Greenfile, combining terms for pregnant women and children with interventions or policy approaches to reduce HAP from biomass fuels or HAP terms and LMIC countries. Included studies will be those reporting (i) pregnant women and children under 5 years; (ii) fuel transition, structural, educational or policy interventions; and (iii) health events associated with HAP exposure which occur among pregnant women or among children within the perinatal period, infancy and up to 5 years of age. A narrative synthesis will be undertaken for each population-intervention-outcome triad stratified by study design. Clinical and methodological homogeneity within each triad will be used to determine the feasibility for undertaking meta-analyses to give a summary estimate of the effect for each outcome. DISCUSSION This systematic review will identify the effectiveness of existing HAP intervention measures in LMIC contexts, with discussion on the context of implementation and adoption, and summarise current literature of relevance to maternal and child health. This assessment reflects the need for HAP interventions which achieve measurable health benefits, which would need to be supported by policies that are socially and economically acceptable in LMIC settings worldwide. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020164998.
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Affiliation(s)
- Katherine E Woolley
- Institute of Applied Heath Research, University of Birmingham, Birmingham, UK
| | | | | | - Tosin Oludotun
- Institute of Applied Heath Research, University of Birmingham, Birmingham, UK
| | - Bruce Kirenga
- Makerere University Lung Institute, College of Health Sciences, Mulago Hospital, Kampala, Uganda
| | - Shelton T Mariga
- Makerere University Lung Institute, College of Health Sciences, Mulago Hospital, Kampala, Uganda
| | - Telesphore Kabera
- University of Rwanda College of Science and Technology, Kigali, Rwanda
| | - April Coombe
- Institute of Applied Heath Research, University of Birmingham, Birmingham, UK
| | - Francis D Pope
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Ajit Singh
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - William R Avis
- International Development Department, University of Birmingham, Edgbaston, Birmingham, UK
| | - Rosie Day
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - David Warburton
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, USA
| | | | - David J Moore
- Institute of Applied Heath Research, University of Birmingham, Birmingham, UK
| | - G Neil Thomas
- Institute of Applied Heath Research, University of Birmingham, Birmingham, UK
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Assessing the Respiratory Effects of Air Pollution from Biomass Cookstoves on Pregnant Women in Rural India. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010183. [PMID: 33383756 PMCID: PMC7795669 DOI: 10.3390/ijerph18010183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 12/24/2020] [Accepted: 12/24/2020] [Indexed: 11/19/2022]
Abstract
Background: In India, biomass fuel is burned in many homes under inefficient conditions, leading to a complex milieu of particulate matter and environmental toxins known as household air pollution (HAP). Pregnant women are particularly vulnerable as they and their fetus may suffer from adverse consequences of HAP. Fractional exhaled nitric oxide (FeNO) is a noninvasive, underutilized tool that can serve as a surrogate for airway inflammation. We evaluated the prevalence of respiratory illness, using pulmonary questionnaires and FeNO measurements, among pregnant women in rural India who utilize biomass fuel as a source of energy within their home. Methods: We prospectively studied 60 pregnant women in their 1st and 2nd trimester residing in villages near Nagpur, Central India. We measured FeNO levels in parts per billion (ppb), St. George’s Respiratory Questionnaire (SGRQ-C) scores, and the Modified Medical Research Council (mMRC) Dyspnea Scale. We evaluated the difference in the outcome distributions between women using biomass fuels and those using liquefied petroleum gas (LPG) using two-tailed t-tests. Results: Sixty-five subjects (32 in Biomass households; 28 in LPG households; 5 unable to complete) were enrolled in the study. Age, education level, and second-hand smoke exposure were comparable between both groups. FeNO levels were higher in the Biomass vs. LPG group (25.4 ppb vs. 8.6 ppb; p-value = 0.001). There was a difference in mean composite SGRQ-C score (27.1 Biomass vs. 10.8 LPG; p-value < 0.001) including three subtotal scores for Symptoms (47.0 Biomass vs. 20.2 LPG; p-value< 0.001), Activity (36.4 Biomass vs. 16.5 LPG; p-value < 0.001) and Impact (15.9 Biomass vs. 5.2 LPG; p-value < 0.001). The mMRC Dyspnea Scale was higher in the Biomass vs. LPG group as well (2.9 vs. 0.5; p < 0.001). Conclusion: Increased FeNO levels and higher dyspnea scores in biomass-fuel-exposed subjects confirm the adverse respiratory effects of this exposure during pregnancy. More so, FeNO may be a useful, noninvasive biomarker of inflammation that can help better understand the physiologic effects of biomass smoke on pregnant women. In the future, larger studies are needed to characterize the utility of FeNO in a population exposed to HAP.
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Qiu G, Yu K, Yu C, Li W, Lv J, Guo Y, Bian Z, Yang L, Chen Y, Chen Z, Hu FB, Li L, Wu T. Association of exhaled carbon monoxide with risk of cardio-cerebral-vascular disease in the China Kadoorie Biobank cohort study. Sci Rep 2020; 10:19507. [PMID: 33177548 PMCID: PMC7659340 DOI: 10.1038/s41598-020-76353-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 10/22/2020] [Indexed: 11/09/2022] Open
Abstract
Exhaled carbon monoxide (COex) level has been proposed as a noninvasive and easily-obtainable cardiovascular risk marker, however, with limited prospective evidence, and its association with stroke risk has been rarely explored. Measurements of COex were performed during 2004-2008 baseline examinations in the China Kadoorie Biobank study among 512,891 adults aged 30-79 years from 10 diverse study areas. After excluding participants with baseline cardiopulmonary diseases, stroke and cancer, 178,485 men and 267,202 women remained. Cox regression yielded hazard ratios (HRs) and 95% confidence intervals (CIs) for risk of cardio-cerebral-vascular disease (CCVD) associated with COex levels, with sequential addition of adjustment for proxy variables for CO exposure, including study area indexing ambient CO variations at large, and smoking and solid fuel use, apart from adjusting for traditional cardiovascular risk factors. During 7-year follow-up, we documented 1744 and 1430 major coronary events (myocardial infarction plus fatal ischemic heart disease), 8849 and 10,922 ischemic strokes, and 2492 and 2363 hemorrhagic strokes among men and women, respectively. The HRs with 95% CIs comparing the highest with lowest COex quintile were 2.15 [1.72, 2.69] for major coronary events, 1.65 [1.50, 1.80] for ischemic stroke, and 1.35 [1.13, 1.61] for hemorrhagic stroke among men, while among women higher associated risk was only observed for major coronary events (1.64 [1.35, 2.00]) and ischemic stroke (1.87 [1.73, 2.01]). The elevated risks were consistent when COex level was over 3 ppm. However, these associations were all attenuated until null by sequential addition of stratification by study areas, and adjustments of smoking and solid fuel use. Nevertheless, the association with ischemic stroke was maintained among the subgroup of male smokers even with adjustment for the depth and amount of cigarette smoking (HR [95% CI]: 1.37 [1.06, 1.77]), while a negative association with hemorrhagic stroke also appeared within this subgroup. Higher COex level (over 3 ppm) was associated with elevated risk of ischemic CCVD, but not independently of CO exposure. Our finding suggests that, though not an independent risk factor, COex could potentially provide a cost-effective biomarker for ischemic cardio-cerebral-vascular risk, given that CO exposure is ubiquitous.
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Affiliation(s)
- Gaokun Qiu
- Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hongkong Rd, Wuhan, 430030, Hubei, People's Republic of China.
| | - Kuai Yu
- Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hongkong Rd, Wuhan, 430030, Hubei, People's Republic of China
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Beijing, 100191, People's Republic of China
| | - Wending Li
- Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hongkong Rd, Wuhan, 430030, Hubei, People's Republic of China
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Beijing, 100191, People's Republic of China
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Ling Yang
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yiping Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Zhengming Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Frank B Hu
- Department of Nutrition and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Beijing, 100191, People's Republic of China.
- Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
| | - Tangchun Wu
- Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hongkong Rd, Wuhan, 430030, Hubei, People's Republic of China.
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Adetona O, Ozoh OB, Oluseyi T, Uzoegwu Q, Odei J, Lucas M. An exploratory evaluation of the potential pulmonary, neurological and other health effects of chronic exposure to emissions from municipal solid waste fires at a large dumpsite in Olusosun, Lagos, Nigeria. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:30885-30892. [PMID: 32537691 DOI: 10.1007/s11356-020-09701-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 06/11/2020] [Indexed: 06/11/2023]
Abstract
Open municipal solid waste (MSW) combustion is a major emission source of particulate air pollution, polycyclic aromatic hydrocarbons, and more exotic hazardous organic pollutants including polychlorinated biphenyls and brominated flame retardants. However, the adverse impact of MSW combustion emission on health among the general population is unknown. Therefore, a cross-sectional study was conducted to explore the associations between potential exposure to MSW combustion-related air pollution and symptoms of adverse health effects among residents of a community adjacent to a large open landfill in Lagos, Nigeria. Using ordinal logistic regression and controlling for age, sex, and smoking, it was observed that residence for ≥ 11 years had increased odds (p < 0.05) of daily occurrence of tingling/numbness/whiteness of fingers (2.614), headaches (2.725), memory problems (2.869), tremor/cramps (2.748), and confusion (3.033) among other symptoms. These results indicate adverse health impacts of chronic exposure to MSW combustion emission.
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Affiliation(s)
- Olorunfemi Adetona
- Division of Environmental Health Sciences, College of Public Health,, The Ohio State University, Columbus, OH, USA
- Division of Biostatistics, College of Public Health,, The Ohio State University, Columbus, OH, USA
| | - Obianuju B Ozoh
- Department of Medicine, College of Medicine,, University of Lagos, Lagos,, Nigeria.
| | | | - Queen Uzoegwu
- Department of Chemistry,, University of Lagos, Lagos, Nigeria
| | - James Odei
- Division of Environmental Health Sciences, College of Public Health,, The Ohio State University, Columbus, OH, USA
- Division of Biostatistics, College of Public Health,, The Ohio State University, Columbus, OH, USA
| | - Maria Lucas
- Division of Environmental Health Sciences, College of Public Health,, The Ohio State University, Columbus, OH, USA
- Division of Biostatistics, College of Public Health,, The Ohio State University, Columbus, OH, USA
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Pratiti R, Vadala D, Kalynych Z, Sud P. Health effects of household air pollution related to biomass cook stoves in resource limited countries and its mitigation by improved cookstoves. ENVIRONMENTAL RESEARCH 2020; 186:109574. [PMID: 32668541 DOI: 10.1016/j.envres.2020.109574] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/20/2020] [Accepted: 04/22/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Household air pollution (HAP) related to cooking is associated with significant global morbidity and mortality. An estimated three billion people worldwide are exposed to cooking related HAP caused by solid fuel combustion. This exposure is highest for the vulnerable population of women and children resulting in significant cumulative health effects. METHODS A literature review was conducted for health effects of household air pollution related to biomass cookstoves in resource limited countries and to evaluate the effect of improved cookstoves on these health effects. We searched PubMed, Embase and Cochrane Library. We conducted searches in January 2018 with a repeat in February 2020. We included only studies conducted in resource limited countries, published in English, irrespective of publication year and studies that examined the health effects of HAP and/or studied the effects of improved cookstove (IC). Two authors independently screened journal article titles, abstracts and full-text articles to identify those that included the following search term: biomass cookstoves and health risks. We also assessed the limitations of IC with barriers to their uptake. RESULTS Health effects associated with HAP mostly include increased blood pressure (BP), dyspnea, childhood pneumonia, lung cancer, low birthweight and cardiovascular diseases. Being a global problem with divergent environmental factors including wide variety of fuel used, housing condition, foods prepared, climatic condition and social factors; most solutions though efficient seems inadequate. Improved cookstove (IC) mitigates emissions and improves short term health, though few randomized long-term studies could substantiate its long-standing continuance and health benefits. CONCLUSION There is ample data about the health effects of HAP, with some benefit with IC intervention for elevated blood pressure, dyspnea symptoms, mutagenicity and cardiovascular diseases. IC does not have any benefit in pregnancy outcomes or children health.
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Affiliation(s)
- Rebecca Pratiti
- McLaren HealthCare, G-3245 Beecher Rd, Flint, MI, 48532, USA.
| | - David Vadala
- McLaren HealthCare, G-3245 Beecher Rd, Flint, MI, 48532, USA
| | - Zirka Kalynych
- McLaren HealthCare, G-3245 Beecher Rd, Flint, MI, 48532, USA
| | - Parul Sud
- McLaren HealthCare, G-3245 Beecher Rd, Flint, MI, 48532, USA
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Fedak KM, Good N, Walker ES, Balmes J, Brook RD, Clark ML, Cole-Hunter T, Devlin R, L'Orange C, Luckasen G, Mehaffy J, Shelton R, Wilson A, Volckens J, Peel JL. Acute changes in lung function following controlled exposure to cookstove air pollution in the subclinical tests of volunteers exposed to smoke (STOVES) study. Inhal Toxicol 2020; 32:115-123. [PMID: 32297528 DOI: 10.1080/08958378.2020.1751750] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background: Exposure to household air pollution generated as a result of cooking and heating is a leading contributor to global disease. The effects of cookstove-generated air pollution on adult lung function, however, remain uncertain.Objectives: We investigated acute responses in lung function following controlled exposures to cookstove-generated air pollution.Methods: We recruited 48 healthy adult volunteers to undergo six two-hour treatments: a filtered-air control and emissions from five different stoves with fine particulate matter (PM2.5) targets from 10 to 500 µg/m3. Spirometry was conducted prior to exposure and immediately, and three and 24 h post-exposure. Mixed-effect models were used to estimate differences in post-exposure lung function for stove treatments versus control.Results: Immediately post-exposure, lung function was lower compared to the control for the three highest PM2.5-level stoves. The largest differences were for the fan rocket stove (target 250 µg/m3; forced vital capacity (FVC): -60 mL, 95% confidence interval (95% CI) -135, 15; forced expiratory volume (FEV1): -51 mL, 95% CI -117, 16; mid-expiratory flow (FEF25-75): -116 mL/s, 95% CI -239, 8). At 3 h post-exposure, lung function was lower compared to the control for all stove treatments; effects were of similar magnitude for all stoves. At 24 h post-exposure, results were consistent with a null association for FVC and FEV1; FEF25-75 was lower relative to the control for the gasifier, fan rocket, and three stone fire.Conclusions: Patterns suggesting short-term decreases in lung function follow from exposure to cookstove air pollution even for stove exposures with low PM2.5 levels.
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Affiliation(s)
- Kristen M Fedak
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Nicholas Good
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Ethan S Walker
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - John Balmes
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Robert D Brook
- Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Maggie L Clark
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Tom Cole-Hunter
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA.,Centre for Air pollution, energy, and health Research, University of New South Wales, Sydney, Australia.,International Laboratory for Air Quality and Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.,Science and Engineering Faculty, Queensland University of Technology, Brisbane, Australia
| | - Robert Devlin
- Environmental Public Health Division, United States Environmental Protection Agency, Durham, NC, USA
| | - Christian L'Orange
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | | | - John Mehaffy
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Rhiannon Shelton
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Ander Wilson
- Department of Statistics, Colorado State University, Fort Collins, CO, USA
| | - John Volckens
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Jennifer L Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
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Walker ES, Clark ML, Young BN, Rajkumar S, Benka-Coker ML, Bachand AM, Brook RD, Nelson TL, Volckens J, Reynolds SJ, L’Orange C, Africano S, Pinel ABO, Good N, Koehler K, Peel JL. Exposure to household air pollution from biomass cookstoves and self-reported symptoms among women in rural Honduras. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2020; 30:160-173. [PMID: 30760020 PMCID: PMC6692243 DOI: 10.1080/09603123.2019.1579304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 12/31/2018] [Indexed: 06/09/2023]
Abstract
Household air pollution from combustion of solid fuels is an important risk factor for morbidity and mortality, causing an estimated 2.6 million premature deaths globally in 2016. Self-reported health symptoms are a meaningful measure of quality of life, however, few studies have evaluated symptoms and quantitative measures of exposure to household air pollution. We assessed the cross-sectional association of self-reported symptoms and exposures to household air pollution among women in rural Honduras using stove type (traditional [n = 76]; cleaner-burning Justa [n = 74]) and 24-hour average personal and kitchen fine particulate matter (PM2.5) concentrations. The odds of prevalent symptoms were higher among women using traditional stoves vs Justa stoves (e.g. headache: odds ratio = 2.23; 95% confidence interval = 1.13-4.39). Associations between symptoms and measured PM2.5 were generally consistent with the null. These results add to the evidence suggesting reduced exposures and better health-related quality of life among women using cleaner-burning biomass stoves.
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Affiliation(s)
- Ethan S. Walker
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Maggie L. Clark
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Bonnie N. Young
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Sarah Rajkumar
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Megan L. Benka-Coker
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Annette M. Bachand
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Robert D. Brook
- Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Tracy L. Nelson
- Department of Health and Exercise Science and Colorado School of Public Health, Colorado State University, Fort Collins, CO, USA
| | - John Volckens
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Stephen J. Reynolds
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
- Mountain and Plains ERC, Denver, CO, USA
| | - Christian L’Orange
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | | | | | - Nicholas Good
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Kirsten Koehler
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer L. Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
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31
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Rylance S, Jewell C, Naunje A, Mbalume F, Chetwood JD, Nightingale R, Zurba L, Flitz G, Gordon SB, Lesosky M, Balmes JR, Mortimer K. Non-communicable respiratory disease and air pollution exposure in Malawi: a prospective cohort study. Thorax 2020; 75:220-226. [PMID: 32079666 PMCID: PMC7063402 DOI: 10.1136/thoraxjnl-2019-213941] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 12/09/2019] [Accepted: 01/06/2020] [Indexed: 01/01/2023]
Abstract
RATIONALE There are no population-based studies from sub-Saharan Africa describing longitudinal lung function in adults. OBJECTIVES To explore the lung function trajectories and their determinants, including the effects of air pollution exposures and the cleaner-burning biomass-fuelled cookstove intervention of the Cooking and Pneumonia Study (CAPS), in adults living in rural Malawi. METHODS We assessed respiratory symptoms and exposures, spirometry and measured 48-hour personal exposure to fine particulate matter (PM2.5) and carbon monoxide (CO), on three occasions over 3 years. Longitudinal data were analysed using mixed-effects modelling by maximum likelihood estimation. MEASUREMENTS AND MAIN RESULTS We recruited 1481 adults, mean (SD) age 43.8 (17.8) years, including 523 participants from CAPS households (271 intervention; 252 controls), and collected multiple spirometry and air pollution measurements for 654 (44%) and 929 (63%), respectively. Compared with Global Lung Function Initiative African-American reference ranges, mean (SD) FEV1 (forced expiratory volume in 1 s) and FVC (forced vital capacity) z-scores were -0.38 (1.14) and -0.19 (1.09). FEV1 and FVC were determined by age, sex, height, previous TB and body mass index, with FEV1 declining by 30.9 mL/year (95% CI: 21.6 to 40.1) and FVC by 38.3 mL/year (95% CI: 28.5 to 48.1). There was decreased exposure to PM2.5 in those with access to a cookstove but no effect on lung function. CONCLUSIONS We did not observe accelerated lung function decline in this cohort of Malawian adults, compared with that reported in healthy, non-smoking populations from high-income countries; this suggests that the lung function deficits we measured in adulthood may have origins in early life.
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Affiliation(s)
- Sarah Rylance
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Lung Health Group, Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | | | - Andrew Naunje
- Lung Health Group, Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Frank Mbalume
- Lung Health Group, Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - John D Chetwood
- John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Rebecca Nightingale
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Lindsay Zurba
- Education for Health Africa, Vereeniging, South Africa
| | - Graham Flitz
- School of Public Health, University of California, Berkeley, California, USA
| | - Stephen B Gordon
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Lung Health Group, Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Maia Lesosky
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Rondebosch, Cape Town, South Africa
| | - John R Balmes
- School of Public Health, University of California, Berkeley, California, USA
- Environmental Health Sciences Division, University of California San Francisco, San Francisco, California, USA
| | - Kevin Mortimer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
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Air Pollution in Rural Households Due to Solid Biomass Fuel Use and Its Health Impacts. LECTURE NOTES IN CIVIL ENGINEERING 2020. [DOI: 10.1007/978-981-15-1334-3_4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Cookstove Trials and Tribulations: What Is Needed to Decrease the Burden of Household Air Pollution? Ann Am Thorac Soc 2019; 15:539-541. [PMID: 29466681 DOI: 10.1513/annalsats.201710-831gh] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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34
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North CM, MacNaughton P, Lai PS, Vallarino J, Okello S, Kakuhikire B, Tsai AC, Castro MC, Siedner MJ, Allen JG, Christiani DC. Personal carbon monoxide exposure, respiratory symptoms, and the potentially modifying roles of sex and HIV infection in rural Uganda: a cohort study. Environ Health 2019; 18:73. [PMID: 31429759 PMCID: PMC6701123 DOI: 10.1186/s12940-019-0517-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 08/12/2019] [Indexed: 05/04/2023]
Abstract
BACKGROUND Most of the global burden of pollution-related morbidity and mortality is believed to occur in resource-limited settings, where HIV serostatus and sex may influence the relationship between air pollution exposure and respiratory morbidity. The lack of air quality monitoring networks in these settings limits progress in measuring global disparities in pollution-related health. Personal carbon monoxide monitoring may identify sub-populations at heightened risk for air pollution-associated respiratory morbidity in regions of the world where the financial cost of air quality monitoring networks is prohibitive. METHODS From September 2015 through May 2017, we measured 48-h ambulatory carbon monoxide (CO) exposure in a longitudinal cohort of HIV-infected and uninfected adults in rural southwestern Uganda. We fit generalized mixed effects models to identify correlates of CO exposure exceeding international air quality thresholds, quantify the relationship between CO exposure and respiratory symptoms, and explore potential effect modification by sex and HIV serostatus. RESULTS Two hundred and sixty study participants completed 419 sampling periods. Personal CO exposure exceeded international thresholds for 50 (19%) participants. In covariate-adjusted models, living in a home where charcoal was the main cooking fuel was associated with CO exposure exceeding international thresholds (adjusted odds ratio [AOR] 11.3, 95% confidence interval [95%CI] 4.7-27.4). In sex-stratified models, higher CO exposure was associated with increased odds of respiratory symptoms among women (AOR 3.3, 95%CI 1.1-10.0) but not men (AOR 1.3, 95%CI 0.4-4.4). In HIV-stratified models, higher CO exposure was associated with increased odds of respiratory symptoms among HIV-infected (AOR 2.5, 95%CI 1.01-6.0) but not HIV-uninfected (AOR 1.4, 95%CI 0.1-14.4) participants. CONCLUSIONS In a cohort in rural Uganda, personal CO exposure frequently exceeded international thresholds, correlated with biomass exposure, and was associated with respiratory symptoms among women and people living with HIV. Our results provide support for the use of ambulatory CO monitoring as a low-cost, feasible method to identify subgroups with heightened vulnerability to pollution-related respiratory morbidity in resource-limited settings and identify subgroups that may have increased susceptibility to pollution-associated respiratory morbidity.
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Affiliation(s)
- Crystal M. North
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA 02118 USA
- Harvard T.H. Chan School of Public Health, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | | | - Peggy S. Lai
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA 02118 USA
- Harvard T.H. Chan School of Public Health, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Jose Vallarino
- Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Samson Okello
- Harvard T.H. Chan School of Public Health, Boston, MA USA
- Mbarara University of Science and Technology, Mbarara, Uganda
- University of Virginia Health System, Charlottesville, USA
| | | | - Alexander C. Tsai
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA 02118 USA
- Harvard Medical School, Boston, MA USA
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Mark J. Siedner
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA 02118 USA
- Harvard Medical School, Boston, MA USA
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joseph G. Allen
- Harvard T.H. Chan School of Public Health, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - David C. Christiani
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA 02118 USA
- Harvard T.H. Chan School of Public Health, Boston, MA USA
- Harvard Medical School, Boston, MA USA
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Li S, Xu J, Jiang Z, Luo Y, Yang Y, Yu J. Correlation between indoor air pollution and adult respiratory health in Zunyi City in Southwest China: situation in two different seasons. BMC Public Health 2019; 19:723. [PMID: 31182075 PMCID: PMC6558730 DOI: 10.1186/s12889-019-7063-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 05/29/2019] [Indexed: 11/19/2022] Open
Abstract
Background Indoor environmental quality significantly influences the occurrence of asthma attack. Zunyi District has abundant coal reserves and is regarded as one of the cities that are most severely polluted by high levels of particulate matter in China. This study aimed to examine the correlation of indoor exposure with adult respiratory health, as well as the differences in effect between winter and summer. Methods A cross-sectional epidemiological study was conducted among 1207 adult residents in Zunyi, Guizhou Province of Southwest China in winter and summer. Data on health variables related to asthma and home environmental factors were collected using a modified European Community Respiratory Health Survey II questionnaire. The following data were obtained: samples of particulate matter 2.5 (PM2.5) inside and outside the households under study (n = 20); lung function status, including peak expiratory flow rate, forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and FEV1/FVC ratio. Result The odds ratio (OR) for asthma-like symptoms and asthma in adults using coal stove for cooking or warming, relative to non-users, was 1.73 (95% CI, 1.11–2.69) in winter vs. 1.30 (95% CI, 0.79–2.14) in summer. Adult residents with exposure to cooking oil fumes were at a considerably higher risk of asthma-like symptoms and asthma [OR = 2.65 (95% CI, 1.25 to 5.61) in winter vs. OR = 7.93 (95% CI, 2.54 to 24.75] in summer] than those without such exposure. The prevalence of asthma-like symptoms and asthma was significantly higher in adults with high kitchen risk scores or high sleeping-area risk scores than in those with low scores in both seasons (p < 0.05). The relative kitchen and sleeping area PM2.5 concentrations were higher in winter than in summer (p < 0.05). Lung function was negatively associated with indoor kitchen and sleeping area relative PM2.5 concentration in winter rather than summer (p < 0.001). The effect of exposure to indoor risk factors on lung function among the residents was greater in winter than in summer (p < 0.001). Conclusion Exposure to indoor risk factors, such as aerocontaminants from coal combustion, causes asthma symptoms and reduces pulmonary function. The effect of indoor risk factors on respiratory health among adults with such exposure was greater in winter than in summer. Electronic supplementary material The online version of this article (10.1186/s12889-019-7063-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shixu Li
- School of Public Health, Zunyi Medical University, Zunyi, Guizhou, 563000, People's Republic of China
| | - Jie Xu
- School of Public Health, Zunyi Medical University, Zunyi, Guizhou, 563000, People's Republic of China
| | - Zhigang Jiang
- School of Public Health, Zunyi Medical University, Zunyi, Guizhou, 563000, People's Republic of China
| | - Ya Luo
- School of Public Health, Zunyi Medical University, Zunyi, Guizhou, 563000, People's Republic of China
| | - Yu Yang
- School of Public Health, Zunyi Medical University, Zunyi, Guizhou, 563000, People's Republic of China
| | - Jie Yu
- School of Public Health, Zunyi Medical University, Zunyi, Guizhou, 563000, People's Republic of China.
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Household air pollution from domestic combustion of solid fuels and health. J Allergy Clin Immunol 2019; 143:1979-1987. [DOI: 10.1016/j.jaci.2019.04.016] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 04/29/2019] [Accepted: 04/29/2019] [Indexed: 01/03/2023]
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37
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Gregorczyk-Maga I, Wachsmann A, Olszewska M, Partyka L. Exhaled carbon monoxide levels correlate with incidence of oral mucosal lesions independent of smoking status. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2019; 29:290-300. [PMID: 30375883 DOI: 10.1080/09603123.2018.1541442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 10/24/2018] [Indexed: 06/08/2023]
Abstract
Carbon monoxide (CO) is an important component of tobacco smoke, but also environmental toxicity. This study analyzed possible correlation between exhaled CO level and oral health indicators in two geographically distributed populations during health-promoting public events organized for local communities in cities with high and low environmental pollution in Poland (907 patients). Self-reported, instructor-led, oral health questionnaire was developed to monitor current and previous mucosal lesion incidence. Exhaled CO correlated with subjects smoking status and environmental CO exposure: highest in smoking inhabitants of Krakow (12 ppm), with lower levels in smokers from Kozienice (6.5 ppm) and non-smokers from Krakow (6 ppm), and lowest for Kozienice non-smokers (2 ppm) (p < 0.001). After propensity score matching and adjustment for smoking status, demography and comorbidities odds ratio for mucosal lesion incidence was 1.46 (1.31-1.63), p < 0.001) per 1 ppm increase of exhaled CO level. This result might implicate a possible role of environmental pollution factors in oral health pathology.
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Affiliation(s)
- Iwona Gregorczyk-Maga
- a Department of Pediatric Dentistry, Institute of Dentistry , Jagiellonian University Medical College , Krakow , Poland
| | - Agnieszka Wachsmann
- b Department of Angiology , Jagiellonian University Medical College , Krakow , Poland
| | - Marta Olszewska
- c Department of Pediatrics , Jagiellonian University Medical College , Krakow , Poland
| | - Lukasz Partyka
- b Department of Angiology , Jagiellonian University Medical College , Krakow , Poland
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Gregorczyk-Maga I, Maga M, Wachsmann A, Janik MK, Chrzastek-Janik O, Bajkowski M, Partyka L, Koziej M. Air pollution may affect the assessment of smoking habits by exhaled carbon monoxide measurements. ENVIRONMENTAL RESEARCH 2019; 172:258-265. [PMID: 30822558 DOI: 10.1016/j.envres.2019.01.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 11/28/2018] [Accepted: 01/17/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND While European air quality policies reduce ambient carbon monoxide (CO) concentrations in general, there are still areas affected by high environmental CO exposure from transportation, industry and burning low-quality fossil fuels. We investigated, how these CO amounts might influence exhaled CO measurements used to monitor the smoking status of healthy subjects. METHODS A cross-sectional study of healthy adults living in areas of high air pollution (N = 742) and low air pollution (N = 197) in Poland. They completed a survey regarding their smoking habits and underwent necessary body measurements including exhaled CO concentration levels. RESULTS Ambient CO levels were much higher in highly pollutes cities. Also exhaled CO levels in subjects from high pollution areas were significantly higher, independent of subject smoking status (8.25 ppm vs. 3.26 ppm). Smokers exhaled more CO than non-smokers. Although the duration of smoking did not affect the CO levels, they were proportional to the number of cigarettes smoked during the day, especially for higher amounts of cigarettes and in unpolluted areas. It was possible to differentiate active from passive smokers in all areas, but the difference for passive smokers vs. non-smokers was significant only in low pollution city inhabitants. CONCLUSIONS Exhaled CO levels were confirmed to be a good indicator of smoking status and smoking pattern in healthy subjects. However, high environmental CO levels both increase baseline exhaled CO concentrations in non-smokers affecting their discrimination from passive smokers, and obscure categorizing cigarette consumption in heavy smokers. These findings add important evidence on both understanding of exhaled CO monitoring results and a significance of environmental CO exposure in areas with high pollution.
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Affiliation(s)
- Iwona Gregorczyk-Maga
- Department of Pediatric Dentistry, Institute of Dentistry, Jagiellonian University Medical College, Krakow, Poland.
| | - Mikolaj Maga
- Department of Angiology, Jagiellonian University Medical College, Krakow, Poland
| | - Agnieszka Wachsmann
- Department of Angiology, Jagiellonian University Medical College, Krakow, Poland
| | - Maciej K Janik
- Liver and Internal Medicine Unit, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warszawa, Poland
| | - Olga Chrzastek-Janik
- Department of Radiotherapy, The Maria Sklodowska-Curie Memorial Cancer Centre, Warszawa, Poland
| | | | - Lukasz Partyka
- Department of Angiology, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
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Van Vliet EDS, Kinney PL, Owusu-Agyei S, Schluger NW, Ae-Ngibise KA, Whyatt RM, Jack DW, Agyei O, Chillrud SN, Boamah EA, Mujtaba M, Asante KP. Current respiratory symptoms and risk factors in pregnant women cooking with biomass fuels in rural Ghana. ENVIRONMENT INTERNATIONAL 2019; 124:533-540. [PMID: 30685455 PMCID: PMC7069526 DOI: 10.1016/j.envint.2019.01.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 01/16/2019] [Accepted: 01/16/2019] [Indexed: 05/31/2023]
Abstract
BACKGROUND More than 75% of the population in Ghana relies on biomass fuels for cooking and heating. Household air pollution (HAP) emitted from the incomplete combustion of these fuels has been associated with adverse health effects including respiratory effects in women that can lead to chronic obstructive pulmonary disease (COPD), a major contributor to global HAP-related mortality. HAP is a modifiable risk factor in the global burden of disease, exposure to which can be reduced. OBJECTIVE This study assessed the prevalence of respiratory symptoms, as well as associations between respiratory symptoms and HAP exposure, as measured using continuous personal carbon monoxide (CO), in nonsmoking pregnant women in rural Ghana. METHODS We analyzed current respiratory health symptoms and CO exposures upon enrollment in a subset (n = 840) of the population of pregnant women cooking with biomass fuels and enrolled in the GRAPHS randomized clinical control trial. Personal CO was measured using Lascar continuous monitors. Associations between CO concentrations as well as other sources of pollution exposures and respiratory health symptoms were estimated using logistic regression models. CONCLUSION There was a positive association between CO exposure per 1 ppm increase and a composite respiratory symptom score of current cough (lasting >5 days), wheeze and/or dyspnea (OR: 1.2, p = 0.03). CO was also positively associated with wheeze (OR: 1.3, p = 0.05), phlegm (OR: 1.2, p = 0.08) and reported clinic visit for respiratory infection in past 4 weeks (OR: 1.2, p = 0.09). Multivariate models showed significant associations between second-hand tobacco smoke and a composite outcome (OR: 2.1, p < 0.01) as well as individual outcomes of cough >5 days (OR: 3.1, p = 0.01), wheeze (OR: 2.7, p < 0.01) and dyspnea (OR: 2.2, p = 0.01). Other covariates found to be significantly associated with respiratory outcomes include involvement in charcoal production business and dyspnea, and involvement in burning grass/field and wheeze. Results suggest that exposure to HAP increases the risk of adverse respiratory symptoms among pregnant women using biomass fuels for cooking in rural Ghana.
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Affiliation(s)
| | | | | | - Neil W Schluger
- Columbia University College of Physicians and Surgeons, New York, NY, USA; Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Robin M Whyatt
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Darby W Jack
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Oscar Agyei
- Kintampo Health Research Centre, Kintampo, Ghana
| | - Steven N Chillrud
- Lamont-Doherty Earth Observatory, Columbia University, Palisades, NY, USA
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40
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A clean fuel cookstove is associated with improved lung function: Effect modification by age and secondhand tobacco smoke exposure. Sci Rep 2019; 9:2487. [PMID: 30792415 PMCID: PMC6385496 DOI: 10.1038/s41598-018-37887-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 11/26/2018] [Indexed: 12/05/2022] Open
Abstract
Household air pollution (HAP) secondary to the burning of solid fuels is a major risk factor for the development of COPD. Our study seeks to examine the impact of a clean cookstove, liquid petroleum gas (LPG), on respiratory outcomes. Women (n = 200) from neighboring Indian communities, one cooking with LPG and one with biomass, were enrolled. Spirometry was performed. Relationships between primary cooking fuel and spirometry measures, as raw values, Global Lung Initiative (GLI) percent predicted (pp), and GLI z-scores, were examined using linear regression. Effect modification by age was explored. Women were young (average age 33.3 years), with low education (median 5.0 years), and the majority had multiple sources of air pollution exposures. Overall, the lung function in both groups was poor [FEV1 z-score median −2.05, IQR (−2.64, −1.41). Biomass was associated with lower FEV1/FVC (raw values −7.0, p = 0.04; GLI pp −7.62, p = 0.05, and z-score −0.86, p = 0.05) and FEF25–75 (GLI pp −25.78, p = 0.05, z-score −1.24, p = 0.05), after adjusting for confounders. Increasing impairment in lung function with age was found among biomass users (p-interaction = 0.01). In conclusion, use of a clean fuel cookstove may improve lung function. These findings have broad implications for research and public policy.
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Zhang XF, Yang Y, Yang XY, Tong Q. RETRACTED: LEF-1 gene silencing inhibits pulmonary vascular remodeling and occurrence of pulmonary arterial hypertension through the β-catenin signaling pathway. Biomed Pharmacother 2018; 108:817-827. [PMID: 30372893 DOI: 10.1016/j.biopha.2018.08.118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/15/2018] [Accepted: 08/23/2018] [Indexed: 12/22/2022] Open
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of the authors as the validity of the pulmonary vascular remodeling indicators cannot be guaranteed. The authors tried post publication to reproduce the results of the cell proliferation and cell aging, however they were not able to confirm the data that was presented by the article.
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Affiliation(s)
- Xian-Feng Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Jilin University, Changchun130021, PR China
| | - Yang Yang
- Department of Cardiology, The First Affiliated Hospital of Jilin University, Changchun130021, PR China
| | - Xin-Yu Yang
- Department of Cardiology, The First Affiliated Hospital of Jilin University, Changchun130021, PR China
| | - Qian Tong
- Department of Cardiology, The First Affiliated Hospital of Jilin University, Changchun130021, PR China.
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Katoto PDMC, Murhula A, Kayembe-Kitenge T, Lawin H, Bisimwa BC, Cirhambiza JP, Musafiri E, Birembano F, Kashongwe Z, Kirenga B, Mfinanga S, Mortimer K, De Boever P, Nawrot TS, Nachega JB, Nemery B. Household Air Pollution Is Associated with Chronic Cough but Not Hemoptysis after Completion of Pulmonary Tuberculosis Treatment in Adults, Rural Eastern Democratic Republic of Congo. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2563. [PMID: 30445808 PMCID: PMC6265859 DOI: 10.3390/ijerph15112563] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 11/10/2018] [Accepted: 11/12/2018] [Indexed: 11/25/2022]
Abstract
Little is known about the respiratory health damage related to household air pollution (HAP) in survivors of pulmonary tuberculosis (PTB). In a population-based cross-sectional study, we determined the prevalence and associated predictors of chronic cough and hemoptysis in 441 randomly selected PTB survivors living in 13 remote health zones with high TB burden in the South Kivu province of the Democratic Republic of Congo (DRC). Trained community and health-care workers administered a validated questionnaire. In a multivariate logistic regression, chronic cough was independently associated with HAP (adjusted odds ratios (aOR) 2.10, 95% CI: 1.10⁻4.00) and PTB treatment >6 months (aOR 3.80, 95% CI: 1.62⁻8.96). Among women, chronic cough was associated with cooking ≥3 h daily (aOR 2.74, 95% CI: 1.25⁻6.07) and with HAP (aOR 3.93, 95% CI: 1.15⁻13.43). Independent predictors of hemoptysis were PTB retreatment (aOR 3.04, 95% CI: 1.04⁻5.09) and ignorance of treatment outcome (aOR 2.24, 95% CI: 1.09⁻4.58) but not HAP (aOR 1.86, 95% CI: 0.61⁻5.62). Exposure to HAP proved a major risk factor for chronic cough in PTB survivors, especially in women. This factor is amenable to intervention.
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Affiliation(s)
- Patrick D M C Katoto
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, 300 Leuven, Belgium.
- Department of Internal Medicine and Prof Lurhuma Biomedical Research Laboratory, Mycobacterium Unit, Faculty of Medicine, Catholic University of Bukavu, 02BP, Bukavu, Congo.
| | - Aime Murhula
- Department of Internal Medicine and Prof Lurhuma Biomedical Research Laboratory, Mycobacterium Unit, Faculty of Medicine, Catholic University of Bukavu, 02BP, Bukavu, Congo.
| | - Tony Kayembe-Kitenge
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, 300 Leuven, Belgium.
- Unit of Toxicology and Environment, University hospital of Lubumbashi, School of Public Health Faculty of Medicine, Lubumbashi 1825BP, Congo.
| | - Herve Lawin
- Unit of Teaching and Research in Occupational and Environmental Health, Faculty of Health Sciences, University of Abomey-Calavi (UAC), Cotonou 03BP0490, Benin.
| | - Bertin C Bisimwa
- Department of Internal Medicine and Prof Lurhuma Biomedical Research Laboratory, Mycobacterium Unit, Faculty of Medicine, Catholic University of Bukavu, 02BP, Bukavu, Congo.
- Département de Biologie médicale, Institut Supérieur des Techniques Médicales (ISTM) Bukavu, BP 3036, Bukavu, Congo.
| | - Jean Paul Cirhambiza
- National TB Program, Provincial and national Anti-Leprosy and TB Coordination, BP. 1899, Bukavu, Dem. Congo.
| | - Eric Musafiri
- National TB Program, Provincial and national Anti-Leprosy and TB Coordination, BP. 1899, Bukavu, Dem. Congo.
| | - Freddy Birembano
- National TB Program, Provincial and national Anti-Leprosy and TB Coordination, BP. 1899, Bukavu, Dem. Congo.
| | - Zacharie Kashongwe
- National TB Program, Provincial and national Anti-Leprosy and TB Coordination, BP. 1899, Bukavu, Dem. Congo.
| | - Bruce Kirenga
- Department of Pulmonary Medicine and Lung Institute, Makerere University, PB 7072, Kampala, Uganda.
| | - Sayoki Mfinanga
- National Institute for Medical Research Muhimbili Medical Research Centre, PB 65001, Dar es Salaam, Tanzania.
| | - Kevin Mortimer
- Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK.
| | - Patrick De Boever
- Centre for Environmental Sciences, Hasselt University, Agoralaan, building D, 3590, Diepenbeek, Belgium.
- Health Unit, Flemish Institute for Technological Research (VITO), Vlasmeer7, 2400 Mol, Belgium.
| | - Tim S Nawrot
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, 300 Leuven, Belgium.
- Centre for Environmental Sciences, Hasselt University, Agoralaan, building D, 3590, Diepenbeek, Belgium.
| | - Jean B Nachega
- Department of Medicine and Center for Infectious Diseases, Faculty of Medicine and Health Sciences, Stellenbosch University, 8000, Francie Van Zijl Drive, PB 241, Cape Town, South Africa.
- Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, 21205, MD, USA.
- Departments of Epidemiology, Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, 15210, PA, USA.
| | - Benoit Nemery
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, 300 Leuven, Belgium.
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Patel S, Leavey A, Sheshadri A, Kumar P, Kandikuppa S, Tarsi J, Mukhopadhyay K, Johnson P, Balakrishnan K, Schechtman KB, Castro M, Yadama G, Biswas P. Associations between household air pollution and reduced lung function in women and children in rural southern India. J Appl Toxicol 2018; 38:1405-1415. [PMID: 30047157 PMCID: PMC10545302 DOI: 10.1002/jat.3659] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/08/2018] [Accepted: 06/04/2018] [Indexed: 12/25/2022]
Abstract
Half of the world's population still relies on solid fuels to fulfill its energy needs for cooking and space heating, leading to high levels of household air pollution (HAP), adversely affecting human health and the environment. A cross-sectional cohort study was conducted to investigate any associations between: (1) HAP metrics (mass concentration of particulate matter of aerodynamic size less than 2.5 μm (PM2.5 ), lung-deposited surface area (LDSA) and carbon monoxide (CO)); (2) a range of household and socio-demographic characteristics; and (3) lung function for women and children exposed daily to biomass cookstove emissions, in rural southern India. HAP measurements were collected inside the kitchen of 96 households, and pulmonary function tests were performed for the women and child in each enrolled household. Detailed questionnaires captured household characteristics, health histories and various socio-demographic parameters. Simple linear and logistic regression analysis was performed to examine possible associations between the HAP metrics, lung function and all household/socio-demographic variables. Obstructive lung defects (forced vital capacity (FVC) ≥ lower limit of normal (LLN) and forced expiratory volume in 1 second (FEV1 )/FVC < LLN) were found in 8% of mothers and 9% of children, and restrictive defects (FVC < LLN and FEV1 /FVC ≥ LLN) were found in 17% of mothers and 15% of children. A positive association between LDSA, included for the first time in this type of epidemiological study, and lung function was observed, indicating LDSA is a superior metric compared to PM2.5 to assess effects of PM on lung function. HAP demonstrated a moderate association with subnormal lung function in children. The results emphasize the need to look beyond mass-based PM metrics to assess fully the association between HAP and lung function.
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Affiliation(s)
- Sameer Patel
- Dept. of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130, USA
| | - Anna Leavey
- Dept. of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130, USA
| | - Ajay Sheshadri
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1462, Houston, TX 77030-1402, USA
| | - Praveen Kumar
- Boston College School of Social Work, Chestnut Hill, MA 02467, USA
| | - Sandeep Kandikuppa
- Curriculum in Environment and Ecology, University of North Carolina, Chapel Hill, 3202 Murray Hall, Chapel Hill, NC 27599-3135, USA
| | - Jaime Tarsi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130, USA
| | - Krishnendu Mukhopadhyay
- Department of Environmental Health Engineering, Sri Ramachandra Nagar, Porur, Chennai – 600116, India
| | - Priscilla Johnson
- Department of Physiology, Sri Ramachandra University, Sri Ramachandra Nagar, Porur, Chennai – 600116, India
| | - Kalpana Balakrishnan
- Department of Environmental Health Engineering, Sri Ramachandra Nagar, Porur, Chennai – 600116, India
| | - Kenneth B. Schechtman
- Division of Biostatistics, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130, USA
| | - Mario Castro
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130, USA
| | - Gautam Yadama
- Boston College School of Social Work, Chestnut Hill, MA 02467, USA
| | - Pratim Biswas
- Dept. of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130, USA
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Chen L, Hu G, Fan R, Lv Y, Dai Y, Xu Z. Association of PAHs and BTEX exposure with lung function and respiratory symptoms among a nonoccupational population near the coal chemical industry in Northern China. ENVIRONMENT INTERNATIONAL 2018; 120:480-488. [PMID: 30145312 DOI: 10.1016/j.envint.2018.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/02/2018] [Accepted: 08/02/2018] [Indexed: 06/08/2023]
Abstract
Emissions (particularly aromatic compounds) from coal industries and biomass fuels combustion lead to high health risks for neighboring residents. To investigate the association of polycyclic aromatic hydrocarbons (PAHs) and benzene, toluene, ethylbenzene and 1,2-dimethylbenzene (BTEX) exposure with lung function and respiratory symptoms among adults and children near the coal-chemical industry in Northern China, adults and children from a county dotted with coal chemical industry were chosen as subjects for investigation (investigated area, IR). The control group consisted of adults and children from an agricultural county (control area, CR). The environmental and urinary PAH and BTEX levels of adults and children were determined by isotope dilution liquid chromatography coupled with tandem mass spectrometry. The Mann-Whitney U test and multivariate linear regression models were used to analyze the relationship between pollutant exposure and the respiratory system. The results showed that in an ambient environment, levels of PAHs and BTEX in the IR were significantly higher than those in the CR. Particularly, the concentration profiles for air samples were IR > CR and indoor > outdoor. Both for adults and children, the geometric (GM) concentrations of urinary PAHs and BTEX from the IR were significantly higher than those measured in the CR. Additionally, the urinary PAH exposure level profiles of smokers were higher than those of nonsmokers, indicating that indoor air and smoking were both important nonoccupational exposure sources. The decline of the forced expiratory in the first second (FEV1, %) and the forced expiratory middle flow rate (FEF25%) in children were associated with increasing urinary PAH metabolite levels (p < 0.05). The increase in urinary 1-OHN, 3-OHPhe, 4-OHPhe and 1-OHP levels could be linked to a decrease in FEV1 (r = -0.179, p < 0.05) and FEF25% with the coefficient of -0.166, -0.201 and -0.175 (p < 0.05), respectively. Medical examinations and lung function tests indicated that residents in the IR had higher occurrences of chest inflammation or declining lung function than residents in the CR. Moreover, exposure to PAHs and BTEX could decrease child lung function, though decreased lung function was not observed in adults. Both urinary monitoring and lung function data showed that children were more sensitive to PAH and BTEX exposure than adults.
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Affiliation(s)
- Laiguo Chen
- State Environmental Protection Key Laboratory of Urban Environment & Ecology, South China Institute of Environmental Sciences (SCIES), Ministry of Environmental Protection, Guangzhou 510655, China
| | - Guocheng Hu
- State Environmental Protection Key Laboratory of Urban Environment & Ecology, South China Institute of Environmental Sciences (SCIES), Ministry of Environmental Protection, Guangzhou 510655, China
| | - Ruifang Fan
- Guangdong Provincial Engineering Technology Research Center for Drug and Food Biological Resources Processing and Comprehensive Utilization, School of Life Sciences, South China Normal University, Guangzhou 510631, China.
| | - Yanshan Lv
- Guangdong Provincial Engineering Technology Research Center for Drug and Food Biological Resources Processing and Comprehensive Utilization, School of Life Sciences, South China Normal University, Guangzhou 510631, China
| | - Yanyan Dai
- Guangdong Provincial Engineering Technology Research Center for Drug and Food Biological Resources Processing and Comprehensive Utilization, School of Life Sciences, South China Normal University, Guangzhou 510631, China
| | - Zhencheng Xu
- State Environmental Protection Key Laboratory of Urban Environment & Ecology, South China Institute of Environmental Sciences (SCIES), Ministry of Environmental Protection, Guangzhou 510655, China.
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Panigrahi A, Padhi BK. Chronic bronchitis and airflow obstruction is associated with household cooking fuel use among never-smoking women: a community-based cross-sectional study in Odisha, India. BMC Public Health 2018; 18:924. [PMID: 30053865 PMCID: PMC6062913 DOI: 10.1186/s12889-018-5846-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 07/12/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The use of solid biomass as cooking fuel could be a potential risk factor for chronic bronchitis (CB) and airflow obstruction (AFO) among never-smoking women. The disease burden in India among women is generally underestimated due to limited population-based epidemiological investigations. The aim of the study was to determine the prevalence of CB and AFO among never-smoking women, and its association with household cooking fuel use. METHODS We conducted a community-based cross-sectional study with a representative study sample (N = 1120) in Odisha, India during 2013-14. Study participants, never-smoking women aged 18-49 years, were recruited randomly from the population census. Trained community health volunteers administered a validated questionnaire that aligned with the standards of the Burden of Obstructive Lung Disease (BOLD) initiative and conducted spirometry. Prevalence estimates of CB (defined as "cough with productive of sputum for at least 3 months of the year for at least 2 years") and AFO (pre-bronchodilator forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) < 0.7) was estimated. Indoor PM2.5 exposure data were collected from a subset of 130 of the total 1120 homes in the study settings. Multivariable regression models were used to estimate the associated risk factors. RESULTS Prevalence of CB and AFO were 7.3 and 22.4% respectively among the study participants. Of the study participants, 31% used exclusive liquefied petroleum gas, 18% used mixed fuel and 51% exclusively used solid biomass fuel for household cooking. In adjusted analysis, both CB (odds ratio 1·96, 95% CI: 1.06-3.64; p = 0·031) and AFO (OR 5.55, 95% CI: 3.51-8.78; p < 0·001) were found to be associated with cooking with solid biomass fuel. Interquartile range increases in PM2.5 was associated with significantly lower FEV1/FVC ratio. CONCLUSIONS The study highlights that the estimates of population burden of CB and AFO are much higher than shown in previous epidemiological studies, and that cooking fuel type and time spent on cooking were associated with increased chronic bronchitis as well as decreased lung function as measured by FEV1/FCV ratios. To most accurately understand the current burden of disease and most effectively prevent an escalation in the future disease burden, further epidemiological investigations are warranted.
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Affiliation(s)
| | - Bijaya K. Padhi
- Center for Environmental and Occupational Health, AIPH University, Bhubaneswar, India
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Balmes JR, Eisen EA. Household Air Pollution and Chronic Obstructive Pulmonary Disease. "A Riddle, Wrapped in a Mystery, Inside an Enigma". Am J Respir Crit Care Med 2018; 197:547-549. [PMID: 29373800 DOI: 10.1164/rccm.201801-0033ed] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- John R Balmes
- 1 Department of Medicine University of California, San Francisco San Francisco, California and.,2 School of Public Health University of California, Berkeley Berkeley, California
| | - Ellen A Eisen
- 2 School of Public Health University of California, Berkeley Berkeley, California
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Amaral AFS, Patel J, Kato BS, Obaseki DO, Lawin H, Tan WC, Juvekar SK, Harrabi I, Studnicka M, Wouters EFM, Loh LC, Bateman ED, Mortimer K, Buist AS, Burney PGJ. Airflow Obstruction and Use of Solid Fuels for Cooking or Heating: BOLD Results. Am J Respir Crit Care Med 2018; 197:595-610. [PMID: 28895752 PMCID: PMC6005234 DOI: 10.1164/rccm.201701-0205oc] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 09/06/2017] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Evidence supporting the association of COPD or airflow obstruction with use of solid fuels is conflicting and inconsistent. OBJECTIVE To assess the association of airflow obstruction with self-reported use of solid fuels for cooking or heating. METHODS We analysed 18,554 adults from the BOLD study, who had provided acceptable post-bronchodilator spirometry measurements and information on use of solid fuels. The association of airflow obstruction with use of solid fuels for cooking or heating was assessed by sex, within each site, using regression analysis. Estimates were stratified by national income and meta-analysed. We carried out similar analyses for spirometric restriction, chronic cough and chronic phlegm. MEASUREMENTS AND MAIN RESULTS We found no association between airflow obstruction and use of solid fuels for cooking or heating (ORmen=1.20, 95%CI 0.94-1.53; ORwomen=0.88, 95%CI 0.67-1.15). This was true for low/middle and high income sites. Among never smokers there was also no evidence of an association of airflow obstruction with use of solid fuels (ORmen=1.00, 95%CI 0.57-1.76; ORwomen=1.00, 95%CI 0.76-1.32). Overall, we found no association of spirometric restriction, chronic cough or chronic phlegm with the use of solid fuels. However, we found that chronic phlegm was more likely to be reported among female never smokers and those who had been exposed for ≥20 years. CONCLUSION Airflow obstruction assessed from post-bronchodilator spirometry was not associated with use of solid fuels for cooking or heating.
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Affiliation(s)
- André F S Amaral
- Imperial College London, NHLI - Respiratory Epidemiology, London, United Kingdom of Great Britain and Northern Ireland ;
| | - Jaymini Patel
- Imperial College London, NHLI - Respiratory Epidemiology, London, United Kingdom of Great Britain and Northern Ireland ;
| | - Bernet S Kato
- Imperial College London, 4615, London, London, United Kingdom of Great Britain and Northern Ireland ;
| | | | - Hervé Lawin
- Unit of Teaching and Research in Occupational and Environmental Health, Faculty of Health Sciences, University of Abomey - Calavi , Cotonou, Benin, Cotonou, Benin ;
| | - Wan C Tan
- Univ British Columbia, icapture center, Vancouver, British Columbia, Canada ;
| | - Sanjay K Juvekar
- Vadu Health and Demographic Surveillance System and Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India ;
| | - Imed Harrabi
- Faculty of Medicine, Sousse, Tunisia, Sousse, Tunisia ;
| | | | - Emiel F M Wouters
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, Netherlands ;
| | - Li-Cher Loh
- Penang Medical College, 26696, Georgetown, Pulau Pinang, Malaysia ;
| | | | - Kevin Mortimer
- Liverpool School of Tropical Medicine, 9655, Liverpool, United Kingdom of Great Britain and Northern Ireland ;
| | - A Sonia Buist
- Oregon Health Sciences University, Medicine / Pulmonary & Critical Care, Portland, Oregon, United States ;
| | - Peter G J Burney
- Imperial College, Respiratory Epidemiology and Public Health, London, United Kingdom of Great Britain and Northern Ireland ;
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Lucarelli K, Wyne K, Svenson JE. Improved cookstoves and their effect on carbon monoxide levels in San Lucas Tolimán, Guatemala. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2018; 28:64-70. [PMID: 29380623 DOI: 10.1080/09603123.2018.1429575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Installation of ventilated cookstoves has been shown to improve 24-h carbon monoxide (CO) and particulate exposure in the Guatemalan highlands. However, a survey of villagers around San Lucas Tolimán found much higher than expected CO levels. Our purpose is to evaluate the effects of improved cookstoves on CO levels in these villagers. METHODS This is cross sectional observational study in six rural communities. Blood carboxyhemoglobin (SpCO) was measured at three different times during the day. Stove type and location, as well as any respiratory, eye, or general symptoms reported were recorded. RESULTS 122 patients were included. CO levels were much higher than would be expected in a non-smoking population, with an average level of 4.6 ± 2.3 percent. There was no significant correlation in CO level and stove type or in CO level and time of day. Reported frequency of respiratory and eye symptoms (dyspnea, p = 0.03; cough, p = 0.01; burning eyes, p = 0.001; and excessive tearing, p = 0.001) did vary significantly between improved and unimproved stove groups. CONCLUSION This study found high average SpCO levels in all villagers. This suggests that some contributor other than cookstoves may be an additional driver of individual CO exposure in this area.
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Affiliation(s)
- Katherine Lucarelli
- a Department of Emergency Medicine , University of Wisconsin School of Medicine and Public Health , Madison , WI , USA
| | - Kevin Wyne
- b Department of Family Medicine and Community Health , University of Wisconsin School of Medicine and Public Health , Madison , WI , USA
| | - James E Svenson
- a Department of Emergency Medicine , University of Wisconsin School of Medicine and Public Health , Madison , WI , USA
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Sood A, Assad NA, Barnes PJ, Churg A, Gordon SB, Harrod KS, Irshad H, Kurmi OP, Martin WJ, Meek P, Mortimer K, Noonan CW, Perez-Padilla R, Smith KR, Tesfaigzi Y, Ward T, Balmes J. ERS/ATS workshop report on respiratory health effects of household air pollution. Eur Respir J 2018; 51:51/1/1700698. [PMID: 29301918 DOI: 10.1183/13993003.00698-2017] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 08/08/2017] [Indexed: 12/18/2022]
Abstract
Exposure to household air pollution (HAP) from solid fuel combustion affects almost half of the world population. Adverse respiratory outcomes such as respiratory infections, impaired lung growth and chronic obstructive pulmonary disease have been linked to HAP exposure. Solid fuel smoke is a heterogeneous mixture of various gases and particulates. Cell culture and animal studies with controlled exposure conditions and genetic homogeneity provide important insights into HAP mechanisms. Impaired bacterial phagocytosis in exposed human alveolar macrophages possibly mediates several HAP-related health effects. Lung pathological findings in HAP-exposed individuals demonstrate greater small airways fibrosis and less emphysema compared with cigarette smokers. Field studies using questionnaires, air pollution monitoring and/or biomarkers are needed to better establish human risks. Some, but not all, studies suggest that improving cookstove efficiency or venting emissions may be associated with reduced respiratory symptoms, lung function decline in women and severe pneumonia in children. Current studies focus on fuel switching, stove technology replacements or upgrades and air filter devices. Several governments have initiated major programmes to accelerate the upgrade from solid fuels to clean fuels, particularly liquid petroleum gas, which provides research opportunities for the respiratory health community.
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Affiliation(s)
- Akshay Sood
- University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Nour A Assad
- University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Peter J Barnes
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Andrew Churg
- University of British Columbia, Vancouver, BC, Canada
| | | | - Kevin S Harrod
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hammad Irshad
- Lovelace Respiratory Research Institute, Albuquerque, NM, USA
| | | | | | - Paula Meek
- University of Colorado at Denver, Denver, CO, USA
| | | | | | | | - Kirk R Smith
- University of California School of Public Health, Berkeley, CA, USA
| | | | - Tony Ward
- University of Montana, Missoula, MT, USA
| | - John Balmes
- University of California School of Public Health, Berkeley, CA, USA.,University of California, San Francisco, CA, USA
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Awopeju OF, Nemery B, Afolabi OT, Poels K, Vanoirbeek J, Obaseki DO, Adewole OO, Lawin HA, Vollmer W, Erhabor GE. Biomass smoke exposure as an occupational risk: cross-sectional study of respiratory health of women working as street cooks in Nigeria. Occup Environ Med 2017; 74:737-744. [PMID: 28780568 DOI: 10.1136/oemed-2016-104107] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 06/29/2017] [Accepted: 07/05/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Little is known about respiratory health of women who are occupationally exposed to biomass smoke outside their homes. This study reports the exposure and respiratory health of street cooks in Ile-Ife, Nigeria. METHODS We assessed exposure to biomass smoke by questionnaire in 188 street cooks and 197 control women and by personal diffusive samplers to quantify volatile organic compounds (VOCs) in a subsample of the women. Respiratory symptoms were assessed by a standardised questionnaire, and pulmonary function was assessed by spirometry before and after bronchodilation. Regression analysis was conducted to compare the outcome between the two groups. RESULTS The study included 188 women (median age 40, IQR 30-50 years) who had worked as street cooks for a median of 7 years (IQR 3-15 years) and 197 control women with similar demographics. Benzene concentration in passive samplers worn by the street cooks was significantly higher compared with controls (median (IQR) 119.3 (82.7-343.7) µg/m3 vs 0.0 (0.0-51.2) µg/m3, p<0.001). The odds of reported respiratory symptoms were significantly higher among the street cooks than controls: cough (adjusted OR 4.4, 95% CI 2.2 to 8.5) and phlegm (adjusted OR 3.9, 95% CI 1.5 to 7.3). The street cooks also had higher odd of airway obstruction as measured by forced expiratory volume in 1 s/forced vital capacity <0.7: 11% 3% (adjusted OR of 3.3 (95% CI 1.3 to 8.7)). CONCLUSIONS This study provides evidence of adverse respiratory effects among street cooks using biomass fuels.
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Affiliation(s)
| | - Benoit Nemery
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, Leuven, Belgium
| | | | - Katrien Poels
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, Leuven, Belgium
| | - Jeroen Vanoirbeek
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, Leuven, Belgium
| | | | | | - Hervé Anicet Lawin
- Department of Public Health, Unit of Teaching and Research in Occupational and Environmental Health, University of Abomey-Calavi, Cotonou, Benin
| | - William Vollmer
- Centre for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
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