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Effects of the Use of Air Purifier on Indoor Environment and Respiratory System among Healthy Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103687. [PMID: 32456250 PMCID: PMC7277583 DOI: 10.3390/ijerph17103687] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 12/19/2022]
Abstract
Air purifiers have become popular among ordinary families. However, it remains controversial whether indoor air purification improves the respiratory health of healthy adults. A randomized crossover intervention study was conducted with 32 healthy individuals. The subjects were categorized into two groups. One group continuously used true air purifiers, and the other followed with sham air purifiers for 4 weeks. Following this first intervention, all the subjects underwent a 4-week washout period and continued with the second 4-week intervention with the alternate air purifiers. We collected fine particulate matter (PM) ≤ 2.5 µm in aerodynamic diameter (PM2.5), coarse particulate matter between 2.5 and 10 µm in aerodynamic diameter (PM10–2.5) and ozone (O3). The subjects’ pulmonary function and fractional exhaled nitric oxide (FeNO) were measured during the study period. The indoor PM2.5 concentrations decreased by 11% with the true air purifiers compared to those with sham air purifiers. However, this decrease was not significant (p = 0.08). The air purification did not significantly improve the pulmonary function of the study subjects. In contrast, an increase in the indoor PM10–2.5 and O3 concentration led to a significant decrease in the forced expiratory volume in one second (FEV1.0)/forced vital capacity (FVC) and maximal mid-expiratory flow (MMEF), respectively. In conclusion, air purification slightly improved the indoor PM2.5 concentrations in ordinary homes but had no demonstrable impact on improving health.
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Salvi SS, Brashier BB, Londhe J, Pyasi K, Vincent V, Kajale SS, Tambe S, Mandani K, Nair A, Mak SM, Madas S, Juvekar S, Donnelly LE, Barnes PJ. Phenotypic comparison between smoking and non-smoking chronic obstructive pulmonary disease. Respir Res 2020; 21:50. [PMID: 32050955 PMCID: PMC7017521 DOI: 10.1186/s12931-020-1310-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 01/29/2020] [Indexed: 12/22/2022] Open
Abstract
Background Although COPD among non-smokers (NS-COPD) is common, little is known about this phenotype. We compared NS-COPD subjects with smoking COPD (S-COPD) patients in a rural Indian population using a variety of clinical, physiological, radiological, sputum cellular and blood biomarkers. Methods Two hundred ninety subjects (118 healthy, 79 S-COPD, 93 NS-COPD) performed pre- and post-bronchodilator spirometry and were followed for 2 years to study the annual rate of decline in lung function. Body plethysmography, impulse oscillometry, inspiratory-expiratory HRCT, induced sputum cellular profile and blood biomarkers were compared between 49 healthy, 45 S-COPD and 55 NS-COPD subjects using standardized methods. Spirometric response to oral corticosteroids was measured in 30 female NS-COPD patients. Results Compared to all male S-COPD subjects, 47% of NS-COPD subjects were female, were younger by 3.2 years, had greater body mass index, a slower rate of decline in lung function (80 vs 130 mL/year), more small airways obstruction measured by impulse oscillometry (p < 0.001), significantly less emphysema (29% vs 11%) on CT scans, lower values in lung diffusion parameters, significantly less neutrophils in induced sputum (p < 0.05) and tended to have more sputum eosinophils. Hemoglobin and red cell volume were higher and serum insulin lower in S-COPD compared to NS-COPD. Spirometric indices, symptoms and quality of life were similar between S-COPD and NS-COPD. There was no improvement in spirometry in NS-COPD patients after 2 weeks of an oral corticosteroid. Conclusions Compared to S-COPD, NS-COPD is seen in younger subjects with equal male-female predominance, is predominantly a small-airway disease phenotype with less emphysema, preserved lung diffusion and a slower rate of decline in lung function.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Arjun Nair
- Department of Radiology, Royal Brompton Hospital, London, UK
| | - Sze Mun Mak
- Department of Radiology, Royal Brompton Hospital, London, UK
| | | | | | - Louise E Donnelly
- National Heart & Lung Institute, Imperial College, Dovehouse Street, London, SW3 6lY, UK
| | - Peter J Barnes
- National Heart & Lung Institute, Imperial College, Dovehouse Street, London, SW3 6lY, UK.
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Xing X, Hu L, Guo Y, Bloom MS, Li S, Chen G, Yim SHL, Gurram N, Yang M, Xiao X, Xu S, Wei Q, Yu H, Yang B, Zeng X, Chen W, Hu Q, Dong G. Interactions between ambient air pollution and obesity on lung function in children: The Seven Northeastern Chinese Cities (SNEC) Study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 699:134397. [PMID: 31677469 DOI: 10.1016/j.scitotenv.2019.134397] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/23/2019] [Accepted: 09/09/2019] [Indexed: 06/10/2023]
Abstract
Children are vulnerable to air pollution-induced lung function deficits, and the prevalence of obesity has been increasing in children. To evaluate the joint effects of long-term PM1 (particulate matter with an aerodynamic diameter ≤ 1.0 μm) exposure and obesity on children's lung function, a cross-sectional sample of 6740 children (aged 7-14 years) was enrolled across seven northeastern Chinese cities from 2012 to 2013. Weight and lung function, including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), peak expiratory flow (PEF), and maximal mid-expiratory flow (MMEF), were measured according to standardized protocols. Average PM1, PM2.5, PM10 and nitrogen dioxide (NO2) exposure levels were estimated using a spatiotemporal model, and sulphur dioxide (SO2) and ozone (O3) exposure were estimated using data from municipal air monitoring stations. Two-level logistic regression and general linear models were used to analyze the joint effects of body mass index (BMI) and air pollutants. The results showed that long-term air pollution exposure was associated with lung function impairment and there were significant interactions with BMI. Associations were stronger among obese and overweight than normal weight participants (the adjusted odds ratios (95% confidence intervals) for PM1 and lung function impairments in three increasing BMI categories were 1.50 (1.07-2.11) to 2.55 (1.59-4.07) for FVC < 85% predicted, 1.44 (1.03-2.01) to 2.51 (1.53-4.11) for FEV1 < 85% predicted, 1.34 (0.97-1.84) to 2.04 (1.24-3.35) for PEF < 75% predicted, and 1.34 (1.01-1.78) to 1.93 (1.26-2.95) for MMEF < 75% predicted). Consistent results were detected in linear regression models for PM1, PM2.5 and SO2 on FVC and FEV1 impairments (PInteraction < 0.05). These modification effects were stronger among females and older participants. These results can provide policy makers with more comprehensive information for to develop strategies for preventing air pollution induced children's lung function deficits among children.
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Affiliation(s)
- Xiumei Xing
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Liwen Hu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Michael S Bloom
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, NY 12144, USA; Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY 12144, USA
| | - Shanshan Li
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Gongbo Chen
- Department of Global Health, School of Health Sciences, Wuhan University, Wuhan, China
| | - Steve Hung Lam Yim
- Department of Geography and Resource Management, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong, China
| | - Namratha Gurram
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Mo Yang
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Xiang Xiao
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Shuli Xu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Qi Wei
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Hongyao Yu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Boyi Yang
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Xiaowen Zeng
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Wen Chen
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Qiang Hu
- Department of Pediatric Surgery, Weifang People's Hospital, Weifang 261041, China.
| | - Guanghui Dong
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
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Brakema EA, van der Kleij RM, Vermond D, van Gemert FA, Kirenga B, Chavannes NH. Let's stop dumping cookstoves in local communities. It's time to get implementation right. NPJ Prim Care Respir Med 2020; 30:3. [PMID: 31924825 PMCID: PMC6954235 DOI: 10.1038/s41533-019-0160-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 11/20/2019] [Indexed: 11/18/2022] Open
Affiliation(s)
- Evelyn A Brakema
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.
| | - Rianne Mjj van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Debbie Vermond
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Frederik A van Gemert
- Department of General Practice & Elderly Care Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Unit of Global Health, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bruce Kirenga
- Department of Medicine and Makerere Lung Institute, Makerere University, Kampala, Uganda
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
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Velasco-Torres Y, Ruiz-López V, Pérez-Bautista O, Buendía-Roldan I, Ramírez-Venegas A, Pérez-Ramos J, Falfán-Valencia R, Ramos C, Montaño M. miR-34a in serum is involved in mild-to-moderate COPD in women exposed to biomass smoke. BMC Pulm Med 2019; 19:227. [PMID: 31775690 PMCID: PMC6882367 DOI: 10.1186/s12890-019-0977-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 10/31/2019] [Indexed: 02/08/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities. The main causes of COPD are Gene-environment interactions associated with tobacco smoking (COPD-TS) and biomass smoke (COPD-BS). It is well know that microRNAs (miRNAs) participate in the control of post-transcriptional regulation and are involved in COPD-TS; nevertheless, those miRNAS are participating in the COPD-BS are unidentified. Thus, we studied which miRNAs are involved in COPD-BS (GOLD stages I–II). Methods In the screening phase, the profile of the miRNAs was analyzed in serum samples (n = 3) by means of a PCR array. Subsequently, the miRNAs were validated with RT-qPCR (n = 25) in the corresponding study groups. Additionally, the serum concentration of Notch1 was measured comparing COPD-BS vs COPD-TS. Results miR-34a was down-regulated in COPD- BS vs COPD-TS. In the other study groups, three miRNAs were differentially expressed: miR-374a was down-regulated in COPD-BS vs C, miR-191-5p was up-regulated in COPD-BS vs H-BS, and miR-21-5p was down-regulated in COPD-TS compared to the C group. Moreover, the serum concentration of Notch1, one of the targets of miR-34a, was increased in COPD-BS compared to women with COPD-TS. Conclusions This is the first study in patients with COPD due to biomass that demonstrates miRNA expression differences between patients. The observations support the concept that COPD by biomass has a different phenotype than COPD due to tobacco smoking, which could have important implications for the treatment of these diseases.
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Affiliation(s)
- Yadira Velasco-Torres
- Department of Biological Systems, Autonomous Metropolitan University-Xochimilco (UAM-X), Mexico City, Mexico.,Biological and Health Sciences, Autonomous Metropolitan University-Xochimilco (UAM-X), Mexico City, Mexico
| | | | | | - Ivette Buendía-Roldan
- Laboratory of Translational Research in Aging and Pulmonary Fibrosis, Mexico City, Mexico
| | | | - Julia Pérez-Ramos
- Department of Biological Systems, Autonomous Metropolitan University-Xochimilco (UAM-X), Mexico City, Mexico
| | - Ramcés Falfán-Valencia
- Laboratory of HLA, National Institute of Respiratory Diseases Ismael Cosio Villegas (INER), Calzada de Tlalpan 4502, Col Section XVI, C.P. 14080, Tlalpan, Mexico City, Mexico
| | - Carlos Ramos
- Laboratory of Cell Biology, Department of Research in Pulmonary Fibrosis, Mexico City, Mexico.
| | - Martha Montaño
- Laboratory of Cell Biology, Department of Research in Pulmonary Fibrosis, Mexico City, Mexico.
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Moschovis PP, Hibberd PL. Household air pollution-related lung disease: protecting the children. Thorax 2019; 74:1018-1019. [PMID: 31615928 PMCID: PMC6995330 DOI: 10.1136/thoraxjnl-2019-214134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Peter P Moschovis
- Divisions of Pulmonary Medicine and Global Health, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Patricia L Hibberd
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
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Read C, Parton KA. The impact of the 1952 London smog event and its relevance for current wood-smoke abatement strategies in Australia. JOURNAL OF THE AIR & WASTE MANAGEMENT ASSOCIATION (1995) 2019; 69:1049-1058. [PMID: 31124747 DOI: 10.1080/10962247.2019.1623936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 05/09/2019] [Accepted: 05/09/2019] [Indexed: 06/09/2023]
Abstract
There is a certain complacency about air pollution in rural towns in Australia. An image of crystal clear skies seems to dominate general perceptions, and few locations actually monitor air pollution levels. Nevertheless, where measurements have been made, particulates have been shown to be the major type of air pollution, and they do reach levels expected to impact on human health. In this article, the contemporary attitudes and behaviour of the government and the population in rural and regional Australia are shown to have a strong resemblance to those that were prevalent prior to the smog events in London in December 1952. Wood smoke poses similar significant health issues in many countries. Insights obtained from the London events, together with more recent research results, are applied to the Australian situation to suggest policy options that are likely to be successful in overcoming the health effects of particulate pollution. Implications: The contemporary attitudes and behaviour of the government and the population in rural and regional Australia are shown to have a strong resemblance to those that were prevalent prior to the smog events in London in December 1952. Insights obtained from the London event of 1952, together with more recent research results, are applied to the Australian situation to suggest policy options that are likely to be successful in overcoming the health effects of particulate pollution.
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Affiliation(s)
- Catherine Read
- Institute for Land, Water and Society, School of Management and Marketing, Charles Sturt University , Orange NSW , Australia
| | - Kevin A Parton
- Institute for Land, Water and Society, School of Management and Marketing, Charles Sturt University , Orange NSW , Australia
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Effects and acceptability of implementing improved cookstoves and heaters to reduce household air pollution: a FRESH AIR study. NPJ Prim Care Respir Med 2019; 29:32. [PMID: 31417087 PMCID: PMC6695425 DOI: 10.1038/s41533-019-0144-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 07/10/2019] [Indexed: 12/27/2022] Open
Abstract
The objective was to evaluate the effectiveness and acceptability of locally tailored implementation of improved cookstoves/heaters in low- and middle-income countries. This interventional implementation study among 649 adults and children living in rural communities in Uganda, Vietnam and Kyrgyzstan, was performed after situational analyses and awareness programmes. Outcomes included household air pollution (PM2.5 and CO), self-reported respiratory symptoms (with CCQ and MRC-breathlessness scale), chest infections, school absence and intervention acceptability. Measurements were conducted at baseline, 2 and 6–12 months after implementing improved cookstoves/heaters. Mean PM2.5 values decrease by 31% (to 95.1 µg/m3) in Uganda (95%CI 71.5–126.6), by 32% (to 31.1 µg/m3) in Vietnam (95%CI 24.5–39.5) and by 65% (to 32.4 µg/m3) in Kyrgyzstan (95%CI 25.7–40.8), but all remain above the WHO guidelines. CO-levels remain below the WHO guidelines. After intervention, symptoms and infections diminish significantly in Uganda and Kyrgyzstan, and to a smaller extent in Vietnam. Quantitative assessment indicates high acceptance of the new cookstoves/heaters. In conclusion, locally tailored implementation of improved cookstoves/heaters is acceptable and has considerable effects on respiratory symptoms and indoor pollution, yet mean PM2.5 levels remain above WHO recommendations.
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Ramírez-Venegas A, Velázquez-Uncal M, Aranda-Chávez A, Guzmán-Bouilloud NE, Mayar-Maya ME, Pérez Lara-Albisua JL, Hernández-Zenteno RDJ, Flores-Trujillo F, Sansores RH. Bronchodilators for hyperinflation in COPD associated with biomass smoke: clinical trial. Int J Chron Obstruct Pulmon Dis 2019; 14:1753-1762. [PMID: 31496674 PMCID: PMC6689558 DOI: 10.2147/copd.s201314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 04/12/2019] [Indexed: 01/25/2023] Open
Abstract
Introduction The efficacy of long-acting bronchodilators for COPD associated with biomass (BE-COPD) has not been properly evaluated. Objective To determine the acute effect of indacaterol (IND) 150 μg q.d and tiotropium (TIO) 18 μg q.d. on lung hyperinflation, walking distance (WD) and dyspnea during the six-minute walking test (6MWT) in moderate BE-COPD at 30, 60 and 240 mins post-drug administration. Design Randomized, controlled, open-level, crossover noninferiority clinical trial. Forty-two women with BE-COPD were randomly assigned to a bronchodilator sequence: IND–TIO or vice versa. Results There were statistically significant changes over time in inspiratory capacity (IC) (p<0.0001), FEV1 (p<0.0001) and FVC (p<0.0001) when IND was used. When TIO was administered, an increase over all time periods was observed only for FEV1 (p<0.0001) and FVC (p<0.0001), whereas for IC an increase was observed only at 30 mins and 24 hrs after TIO administration. We did not find clinically significant increases in WD and dyspnea after the administration of both bronchodilators. Conclusion Both IND and TIO showed significant and fast onset improvement in hyperinflation. Therefore, either of them may be recommended as a first line of treatment for COPD associated with BE-COPD.
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Affiliation(s)
- Alejandra Ramírez-Venegas
- Department of Tobacco Smoking and COPD Research, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosió Villegas", Mexico City, Mexico
| | - Mónica Velázquez-Uncal
- Department of Tobacco Smoking and COPD Research, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosió Villegas", Mexico City, Mexico
| | - Adrián Aranda-Chávez
- Department of Tobacco Smoking and COPD Research, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosió Villegas", Mexico City, Mexico
| | - Nicolás Eduardo Guzmán-Bouilloud
- Department of Tobacco Smoking and COPD Research, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosió Villegas", Mexico City, Mexico
| | - María Eugenia Mayar-Maya
- Department of Medical Attention, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosió Villegas", Mexico City, Mexico
| | - José Luis Pérez Lara-Albisua
- Department of Tobacco Smoking and COPD Research, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosió Villegas", Mexico City, Mexico
| | - Rafael de Jesus Hernández-Zenteno
- Obstructive Disease Ward, Pulmonary Obstructive Diseases Clinical Service, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
| | - Fernando Flores-Trujillo
- Obstructive Disease Ward, Pulmonary Obstructive Diseases Clinical Service, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
| | - Raúl H Sansores
- Department of Respiratory Medicine, Medica Sur Clinic & Foundation , Mexico City, Mexico
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Abstract
Chronic obstructive pulmonary disease (COPD) is a major global health problem that is poorly treated by current therapies as it has proved difficult to treat the underlying inflammation, which is largely corticosteroid-resistant in most patients. Although rare genetic endotypes of COPD have been recognized, despite the clinical heterogeneity of COPD, it has proved difficult to identify distinct inflammatory endotypes. Most patients have increased neutrophils and macrophages in sputum, reflecting the increased secretion of neutrophil and monocyte chemotactic mediators in the lungs. However, some patients also have increased eosinophils in sputum and this may be reflected by increased blood eosinophils. Increased blood and sputum eosinophils are associated with more frequent exacerbations and predict a good response to corticosteroids in reducing and treating acute exacerbations. Eosinophilic COPD may represent an overlap with asthma but the mechanism of eosinophilia is uncertain as, although an increase in sputum IL-5 has been detected, anti-IL-5 therapies are not effective in preventing exacerbations. More research is needed to link inflammatory endotypes to clinical manifestations and outcomes in COPD and in particular to predict response to precision medicines.
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Affiliation(s)
- Peter J. Barnes
- National Heart and Lung Institute Imperial College London UK
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Simkovich SM, Goodman D, Roa C, Crocker ME, Gianella GE, Kirenga BJ, Wise RA, Checkley W. The health and social implications of household air pollution and respiratory diseases. NPJ Prim Care Respir Med 2019; 29:12. [PMID: 31028270 PMCID: PMC6486605 DOI: 10.1038/s41533-019-0126-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 03/05/2019] [Indexed: 12/29/2022] Open
Abstract
Approximately three billion individuals are exposed to household air pollution (HAP) from the burning of biomass fuels worldwide. Household air pollution is responsible for 2.9 million annual deaths and causes significant health, economic and social consequences, particularly in low- and middle-income countries. Although there is biological plausibility to draw an association between HAP exposure and respiratory diseases, existing evidence is either lacking or conflicting. We abstracted systematic reviews and meta-analyses for summaries available for common respiratory diseases in any age group and performed a literature search to complement these reviews with newly published studies. Based on the literature summarized in this review, HAP exposure has been associated with acute respiratory infections, tuberculosis, asthma, chronic obstructive pulmonary disease, pneumoconiosis, head and neck cancers, and lung cancer. No study, however, has established a causal link between HAP exposure and respiratory disease. Furthermore, few studies have controlled for tobacco smoke exposure and outdoor air pollution. More studies with consistent diagnostic criteria and exposure monitoring are needed to accurately document the association between household air pollution exposure and respiratory disease. Better environmental exposure monitoring is critical to better separate the contributions of household air pollution from that of other exposures, including ambient air pollution and tobacco smoking. Clinicians should be aware that patients with current or past HAP exposure are at increased risk for respiratory diseases or malignancies and may want to consider earlier screening in this population.
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Affiliation(s)
- Suzanne M Simkovich
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Center for Global Non-Communicable Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Dina Goodman
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Center for Global Non-Communicable Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Christian Roa
- Center for Global Non-Communicable Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Mary E Crocker
- Center for Global Non-Communicable Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Division of Pulmonary and Sleep Medicine, University of Washington, Seattle Children's Hospital, Seattle, WA, USA
| | - Gonzalo E Gianella
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
- Servicio de Neumología, Unidad de Cuidados Intensivos, Clinica Ricardo Palma, Lima, Peru
| | - Bruce J Kirenga
- Makerere Lung Institute, Makerere University, Kampala, Uganda
- Pulmonology Unit, Department of Medicine, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Robert A Wise
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
- Center for Global Non-Communicable Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
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Leynaert B, Le Moual N, Neukirch C, Siroux V, Varraso R. [Environmental risk factors for asthma developement]. Presse Med 2019; 48:262-273. [PMID: 30910274 DOI: 10.1016/j.lpm.2019.02.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 12/20/2022] Open
Abstract
The prevalence of asthma has increased rapidly since the early 1970s, and only changes in exposure to environmental factors; which go together with changes in lifestyle, are likely to explain such a rapid increase. Exposure to allergens is a risk factor for allergic sensitization, and allergic sensitization is a risk factor for allergic asthma. However, apart from indoor mold exposure as a risk factor for childhood asthma, there is insufficient evidence to conclude that the associations between allergen exposure and asthma development are causal. A new challenge for research is to analyze the huge amount of data derived from the metagenomic characterization of the environmental and human microbiome, to understand the role of interactions between viruses, bacteria and allergens in the development of asthma. It is recognized that prenatal and postnatal exposure to air pollution and maternal smoking increase the risk of developing asthma in children. In adults, the data are scarce and the results remain controversial as regards these exposures and asthma incidence. Further research is needed to appraise the effect of exposure to phenols, phthalates and perfluorinated compounds, which are widespread in the environment and may be associated with asthma, especially in children. Frequent use of chemicals for home cleaning especially in the form of sprays - which is a common practice at the population level - is a risk factor for the development of adult asthma. The domestic use of cleaning products might also be a risk factor for asthma in children exposed at home. The chemicals involved in these relationships are still to be identified. Occupational asthma is a major phenotype of adult asthma. A significant part of these asthma cases might relate to occupational exposure to cleaning products. While there is evidence of associations between diet during pregnancy or during childhood and the risk of developing asthma in children, the data in adults are insufficient. Beyond genetic factors, body composition is influenced by dietary choices and physical activity. Further research is needed to clarify the complex interplay between these nutritional factors and asthma development. The new challenge for research is to decipher the role of all the environmental factors to which the individual is exposed since conception ("exposome") in the development of asthma, using a holistic approach.
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Affiliation(s)
- Bénédicte Leynaert
- UMR 1152 physiopathologie et épidémiologie des maladies respiratoires, équipe épidémiologie, Inserm, Paris, France; UMR 1152, université Paris Diderot, Paris, France.
| | - Nicole Le Moual
- Inserm U1168, VIMA (aging and chronic diseases, epidemiological and public health approaches), Villejuif, France; UVSQ, UMR-S 1168, université Versailles, Saint-Quentin-en-Yvelines, France
| | - Catherine Neukirch
- UMR 1152 physiopathologie et épidémiologie des maladies respiratoires, équipe épidémiologie, Inserm, Paris, France; UMR 1152, université Paris Diderot, Paris, France; Service de pneumologie A, hôpital Bichat, Assistance publique-Hôpitaux de Paris, Paris, France; DHU FIRE, Paris, France
| | - Valérie Siroux
- Équipe épidémiologie environnement appliquée à la reproduction et la santé respiratoire, Inserm, CNRS, centre de recherche Inserm U1209, institute for advanced biosciences (IAB), université Grenoble-Alpes, Grenoble, France
| | - Raphaëlle Varraso
- Inserm U1168, VIMA (aging and chronic diseases, epidemiological and public health approaches), Villejuif, France; UVSQ, UMR-S 1168, université Versailles, Saint-Quentin-en-Yvelines, France
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Brakema EA, van Gemert FA, van der Kleij RMJJ, Salvi S, Puhan M, Chavannes NH. COPD's early origins in low-and-middle income countries: what are the implications of a false start? NPJ Prim Care Respir Med 2019; 29:6. [PMID: 30837469 PMCID: PMC6401185 DOI: 10.1038/s41533-019-0117-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/28/2019] [Indexed: 01/16/2023] Open
Affiliation(s)
- E A Brakema
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden University, Leiden, The Netherlands.
| | - F A van Gemert
- Department of General Practice Groningen, Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - R M J J van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
| | - S Salvi
- Chest Research Foundation, Pune, India
| | - M Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - N H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
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Nightingale R, Lesosky M, Flitz G, Rylance SJ, Meghji J, Burney P, Balmes J, Mortimer K. Noncommunicable Respiratory Disease and Air Pollution Exposure in Malawi (CAPS). A Cross-Sectional Study. Am J Respir Crit Care Med 2019; 199:613-621. [PMID: 30141966 PMCID: PMC6396863 DOI: 10.1164/rccm.201805-0936oc] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 08/22/2018] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Noncommunicable respiratory diseases and exposure to air pollution are thought to be important contributors to morbidity and mortality in sub-Saharan African adults. OBJECTIVES We set out to explore the prevalence and determinants of noncommunicable respiratory disease among adults living in Chikhwawa District, Malawi. METHODS We performed a cross-sectional study among adults in communities participating in a randomized controlled trial of a cleaner-burning biomass-fueled cookstove intervention (CAPS [Cooking and Pneumonia Study]) in rural Malawi. We assessed chronic respiratory symptoms, spirometric abnormalities, and personal exposure to air pollution (particulate matter <2.5 μm in aerodynamic diameter [PM2.5] and carbon monoxide [CO]). Weighted prevalence estimates were calculated; multivariable and intention-to-treat analyses were done. MEASUREMENTS AND MAIN RESULTS One thousand four hundred eighty-one participants (mean [SD] age, 43.8 [17.8] yr; 57% female) were recruited. The prevalence of chronic respiratory symptoms, spirometric obstruction, and restriction were 13.6% (95% confidence interval [CI], 11.9-15.4), 8.7% (95% CI, 7.0-10.7), and 34.8% (95% CI, 31.7-38.0), respectively. Median 48-hour personal PM2.5 and CO exposures were 71.0 μg/m3 (interquartile range [IQR], 44.6-119.2) and 1.23 ppm (IQR, 0.79-1.93), respectively. Chronic respiratory symptoms were associated with current/ex-smoking (odds ratio [OR], 1.59; 95% CI, 1.05-2.39), previous tuberculosis (OR, 2.50; 95% CI, 1.04-15.58), and CO exposure (OR, 1.46; 95% CI, 1.04-2.05). Exposure to PM2.5 was not associated with any demographic, clinical, or spirometric characteristics. There was no effect of the CAPS intervention on any of the secondary trial outcomes. CONCLUSIONS The burden of chronic respiratory symptoms, abnormal spirometry, and air pollution exposures in adults in rural Malawi is of considerable potential public health importance. We found little evidence that air pollution exposures were associated with chronic respiratory symptoms or spirometric abnormalities and no evidence that the CAPS intervention had effects on the secondary trial outcomes. More effective prevention and control strategies for noncommunicable respiratory disease in sub-Saharan Africa are needed. Clinical trial registered with www.isrctn.com (ISRCTN 59448623).
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Affiliation(s)
- Rebecca Nightingale
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Malawi Liverpool Wellcome Trust Programme, Blantyre, Malawi
| | - Maia Lesosky
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Sarah J. Rylance
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Malawi Liverpool Wellcome Trust Programme, Blantyre, Malawi
| | - Jamilah Meghji
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Malawi Liverpool Wellcome Trust Programme, Blantyre, Malawi
| | - Peter Burney
- National Heart and Lung Institute, Imperial College, London, United Kingdom; and
| | - John Balmes
- University of California, Berkeley, California
- University of California, San Francisco, San Francisco, California
| | - Kevin Mortimer
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Malawi Liverpool Wellcome Trust Programme, Blantyre, Malawi
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65
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Basagaña X. Household air pollution as an important factor in the complex relationship between altitude and COPD. Eur Respir J 2019; 53:53/2/1802454. [PMID: 30759422 DOI: 10.1183/13993003.02454-2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 01/09/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Xavier Basagaña
- ISGlobal, Barcelona, Spain .,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Chan KH, Kurmi OP, Bennett DA, Yang L, Chen Y, Tan Y, Pei P, Zhong X, Chen J, Zhang J, Kan H, Peto R, Lam KBH. Solid Fuel Use and Risks of Respiratory Diseases. A Cohort Study of 280,000 Chinese Never-Smokers. Am J Respir Crit Care Med 2019; 199:352-361. [PMID: 30235936 PMCID: PMC6363974 DOI: 10.1164/rccm.201803-0432oc] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 09/21/2018] [Indexed: 12/13/2022] Open
Abstract
RATIONALE Little evidence from large-scale cohort studies exists about the relationship of solid fuel use with hospitalization and mortality from major respiratory diseases. OBJECTIVES To examine the associations of solid fuel use and risks of acute and chronic respiratory diseases. METHODS A cohort study of 277,838 Chinese never-smokers with no prior major chronic diseases at baseline. During 9 years of follow-up, 19,823 first hospitalization episodes or deaths from major respiratory diseases, including 10,553 chronic lower respiratory disease (CLRD), 4,398 chronic obstructive pulmonary disease (COPD), and 7,324 acute lower respiratory infection (ALRI), were recorded. Cox regression yielded adjusted hazard ratios (HRs) for disease risks associated with self-reported primary cooking fuel use. MEASUREMENTS AND MAIN RESULTS Overall, 91% of participants reported regular cooking, with 52% using solid fuels. Compared with clean fuel users, solid fuel users had an adjusted HR of 1.36 (95% confidence interval, 1.32-1.40) for major respiratory diseases, whereas those who switched from solid to clean fuels had a weaker HR (1.14, 1.10-1.17). The HRs were higher in wood (1.37, 1.33-1.41) than coal users (1.22, 1.15-1.29) and in those with prolonged use (≥40 yr, 1.54, 1.48-1.60; <20 yr, 1.32, 1.26-1.39), but lower among those who used ventilated than nonventilated cookstoves (1.22, 1.19-1.25 vs. 1.29, 1.24-1.35). For CLRD, COPD, and ALRI, the HRs associated with solid fuel use were 1.47 (1.41-1.52), 1.10 (1.03-1.18), and 1.16 (1.09-1.23), respectively. CONCLUSIONS Among Chinese adults, solid fuel use for cooking was associated with higher risks of major respiratory disease admissions and death, and switching to clean fuels or use of ventilated cookstoves had lower risk than not switching.
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Affiliation(s)
- Ka Hung Chan
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Om P. Kurmi
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Derrick A. Bennett
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Ling Yang
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, United Kingdom
| | - Yiping Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, United Kingdom
| | - Yunlong Tan
- Chinese Academy of Medical Sciences, Beijing, China
| | - Pei Pei
- Chinese Academy of Medical Sciences, Beijing, China
| | - Xunfu Zhong
- Pengzhou Center for Disease Control and Prevention, Pengzhou, China
| | | | - Jun Zhang
- Suzhou Center for Disease Control and Prevention, Suzhou, China; and
| | - Haidong Kan
- School of Public Health, Fudan University, Shanghai, China
| | - Richard Peto
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Kin Bong Hubert Lam
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - on behalf of the China Kadoorie Biobank Collaborative Group
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, United Kingdom
- Chinese Academy of Medical Sciences, Beijing, China
- Pengzhou Center for Disease Control and Prevention, Pengzhou, China
- Pengzhou People’s Hospital, Pengzhou, China
- Suzhou Center for Disease Control and Prevention, Suzhou, China; and
- School of Public Health, Fudan University, Shanghai, China
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67
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Barnes PJ, Vestbo J, Calverley PM. The Pressing Need to Redefine "COPD". CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2019; 6:380-383. [PMID: 31710794 DOI: 10.15326/jcopdf.6.5.2019.0173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Peter J Barnes
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, United Kingdom
| | - Peter M Calverley
- Pulmonary and Rehabilitation Research Group, University Hospital Aintree, Liverpool, United Kingdom
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68
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Abstract
Chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis are regarded as a diseases of accelerated lung ageing and show all of the hallmarks of ageing, including telomere shortening, cellular senescence, activation of PI3 kinase-mTOR signaling, impaired autophagy, mitochondrial dysfunction, stem cell exhaustion, epigenetic changes, abnormal microRNA profiles, immunosenescence and a low grade chronic inflammation due to senescence-associated secretory phenotype (SASP). Many of these ageing mechanisms are driven by exogenous and endogenous oxidative stress. There is also a reduction in anti-ageing molecules, such as sirtuins and Klotho, which further accelerate the ageing process. Understanding these molecular mechanisms has identified several novel therapeutic targets and several drugs and dietary interventions are now in development to treat chronic lung disease.
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Affiliation(s)
- Peter J Barnes
- Airway Disease Section, National Heart and Lung Institute, Imperial College, London, UK.
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69
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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: 6] [Impact Index Per Article: 1.0] [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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