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Agache I, Annesi-Maesano I, Cecchi L, Biagioni B, Chung KF, Clot B, D'Amato G, Damialis A, Del Giacco S, Dominguez-Ortega J, Galàn C, Gilles S, Holgate S, Jeebhay M, Kazadzis S, Nadeau K, Papadopoulos N, Quirce S, Sastre J, Tummon F, Traidl-Hoffmann C, Walusiak-Skorupa J, Jutel M, Akdis CA. EAACI guidelines on environmental science for allergy and asthma: The impact of short-term exposure to outdoor air pollutants on asthma-related outcomes and recommendations for mitigation measures. Allergy 2024. [PMID: 38563695 DOI: 10.1111/all.16103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/08/2024] [Accepted: 03/10/2024] [Indexed: 04/04/2024]
Abstract
The EAACI Guidelines on the impact of short-term exposure to outdoor pollutants on asthma-related outcomes provide recommendations for prevention, patient care and mitigation in a framework supporting rational decisions for healthcare professionals and patients to individualize and improve asthma management and for policymakers and regulators as an evidence-informed reference to help setting legally binding standards and goals for outdoor air quality at international, national and local levels. The Guideline was developed using the GRADE approach and evaluated outdoor pollutants referenced in the current Air Quality Guideline of the World Health Organization as single or mixed pollutants and outdoor pesticides. Short-term exposure to all pollutants evaluated increases the risk of asthma-related adverse outcomes, especially hospital admissions and emergency department visits (moderate certainty of evidence at specific lag days). There is limited evidence for the impact of traffic-related air pollution and outdoor pesticides exposure as well as for the interventions to reduce emissions. Due to the quality of evidence, conditional recommendations were formulated for all pollutants and for the interventions reducing outdoor air pollution. Asthma management counselled by the current EAACI guidelines can improve asthma-related outcomes but global measures for clean air are needed to achieve significant impact.
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Affiliation(s)
- Ioana Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
| | - Isabella Annesi-Maesano
- Institute Desbrest of Epidemiology and Public Health, University of Montpellier and INSERM, Montpellier, France
| | - Lorenzo Cecchi
- Centre of Bioclimatology, University of Florence, Florence, Italy
| | - Benedetta Biagioni
- Allergy and Clinical Immunology Unit San Giovanni di Dio Hospital, Florence, Italy
| | - Kian Fan Chung
- National Hearth & Lung Institute, Imperial College London, London, UK
| | - Bernard Clot
- Federal office of meteorology and climatology MeteoSwiss, Payerne, Switzerland
| | - Gennaro D'Amato
- Respiratory Disease Department, Hospital Cardarelli, Naples, Italy
- University of Naples Federico II Medical School of Respiratory Diseases, Naples, Italy
| | - Athanasios Damialis
- Department of Ecology, School of Biology, Faculty of Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy
| | - Javier Dominguez-Ortega
- Department of Allergy, La Paz University Hospital, IdiPAZ, and CIBER of Respiratory Diseases (CIBERES), Madrid, Spain
| | - Carmen Galàn
- Inter-University Institute for Earth System Research (IISTA), International Campus of Excellence on Agrifood (ceiA3), University of Córdoba, Córdoba, Spain
| | - Stefanie Gilles
- Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Stephen Holgate
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Mohamed Jeebhay
- Occupational Medicine Division and Centre for Environmental & Occupational Health Research, University of Cape Town, Cape Town, South Africa
| | - Stelios Kazadzis
- Physikalisch-Meteorologisches Observatorium Davos, World Radiation Center, Davos, Switzerland
| | - Kari Nadeau
- John Rock Professor of Climate and Population Studies, Department of Environmental Health, Center for Climate, Health, and the Global Environment, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Nikolaos Papadopoulos
- Allergy and Clinical Immunology Unit, Second Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
- Division of Evolution and Genomic Sciences, University of Manchester, Manchester, UK
| | - Santiago Quirce
- Department of Allergy, La Paz University Hospital, IdiPAZ, and CIBER of Respiratory Diseases (CIBERES), Madrid, Spain
| | - Joaquin Sastre
- Allergy Service, Fundación Jiménez Díaz, Faculty of Medicine Universidad Autónoma de Madrid and CIBERES, Instituto Carlos III, Ministry of Science and Innovation, Madrid, Spain
| | - Fiona Tummon
- Respiratory Disease Department, Hospital Cardarelli, Naples, Italy
- University of Naples Federico II Medical School of Respiratory Diseases, Naples, Italy
| | - Claudia Traidl-Hoffmann
- Department of Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
- Institute of Environmental Medicine, Helmholtz Center Munich-German Research Center for Environmental Health, Augsburg, Germany
- Christine Kühne Center for Allergy Research and Education, Davos, Switzerland
| | - Jolanta Walusiak-Skorupa
- Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Marek Jutel
- Department of Clinical Immunology, Wrocław Medical University, and ALL-MED Medical Research Institute, Wroclaw, Poland
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich, Davos, Switzerland
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Carreras G, Lugo A, Gallus S, Cortini B, Fernández E, López MJ, Soriano JB, López-Nicolás A, Semple S, Gorini G. Burden of disease attributable to second-hand smoke exposure: A systematic review. Prev Med 2019; 129:105833. [PMID: 31505203 DOI: 10.1016/j.ypmed.2019.105833] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/30/2019] [Accepted: 09/05/2019] [Indexed: 10/26/2022]
Abstract
Our aim was to provide a systematic review of studies on the burden of disease due to second-hand smoke (SHS) exposure, reviewing methods, exposure assessment, diseases causally linked to SHS, health outcomes, and estimates available to date. A literature review of studies on the burden of disease from SHS exposure, available in PubMed and SCOPUS, published 2007-2018 in English language, was carried out following the PRISMA recommendations. Overall, 588 studies were first identified, and 94 were eligible. Seventy-two studies were included in the systematic review. Most of them were based on the comparative risk assessment approach, assessing SHS exposure using mainly surveys on exposure at home/workplaces. Diseases more frequently studied were: lung cancer, ischemic heart disease, stroke, chronic obstructive pulmonary disease, asthma and breast cancer in adults; lower respiratory tract infection, otitis media, asthma, sudden infant death syndrome and low birth weight in children. The SHS exposure assessment and the reported population attributable fractions (PAF) were largely heterogeneous. As an example, the PAF from lung cancer varied between 0.6% and 20.5%. Moreover, PAF were estimated applying relative risks and SHS exposures with no consistent definitions or with different age classes. The research gap on the SHS exposure burden is shrinking. However, estimates are not yet available for a number of countries, particularly the Middle Eastern and African countries, and not all diseases with the strongest evidence of causation, such as sudden infant death syndrome, have been explored. Moreover, in some cases the applied methodology revealed relatively low quality of data.
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Affiliation(s)
- Giulia Carreras
- Oncologic Network, Prevention and Research Institute (ISPRO), via Cosimo il Vecchio 2, 50139 Florence, Italy.
| | - Alessandra Lugo
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS (IRFMN), Via La Masa 19, 20156 Milan, Italy
| | - Silvano Gallus
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS (IRFMN), Via La Masa 19, 20156 Milan, Italy
| | - Barbara Cortini
- Oncologic Network, Prevention and Research Institute (ISPRO), via Cosimo il Vecchio 2, 50139 Florence, Italy
| | - Esteve Fernández
- Catalan Institute of Oncology (ICO), Granvia de L'Hospitalet, 199-203, PC 08908 L'Hospitalet de Llobregat, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Granvia de L'Hospitalet, 199, PC 08908 L'Hospitalet de Llobregat, Spain; Department of Clinical Sciences, Campus de Bellvitge, School of Medicine and Health Sciences, University of Barcelona, Feixa Llarga, s/n, PC 08907 L'Hospitalet de Llobregat, Spain
| | - Maria José López
- Public Health Agency of Barcelona (ASPB). Pl. Lesseps, 1, PC 08023 Barcelona, Spain; CIBER Epidemiologia y Salud Pública (CIBERESP), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0. PC 28029, Madrid, Spain; Institut d'Investigació Biomèdica de Sant Pau (IIB Sant Pau), Sant Antoni Maria Claret, 167, PC 08025 Barcelona, Spain
| | - Joan B Soriano
- Hospital Universitario La Princesa (IISP), Diego de León, 62 1st floor, PC 28006 Madrid, Spain
| | - Angel López-Nicolás
- Polytechnic University of Cartagena (UPCT), Plaza Cronista Isidoro Valverde, s/n, PC 30202 Cartagena, Spain
| | - Sean Semple
- Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, Scotland, UK
| | - Giuseppe Gorini
- Oncologic Network, Prevention and Research Institute (ISPRO), via Cosimo il Vecchio 2, 50139 Florence, Italy
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Continente X, Arechavala T, Fernàndez E, Pérez-Ríos M, Schiaffino A, Soriano JB, Carreras G, López-Nicolás Á, Gorini G, López MJ. Burden of respiratory disease attributable to secondhand smoke exposure at home in children in Spain (2015). Prev Med 2019; 123:34-40. [PMID: 30817956 DOI: 10.1016/j.ypmed.2019.02.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 02/12/2019] [Accepted: 02/23/2019] [Indexed: 10/27/2022]
Abstract
This study aimed to estimate the number of incident cases and hospital admissions attributable to secondhand smoke (SHS) exposure at home for asthma, otitis media (OM), and lower respiratory infections (LRI) in children in Spain. The burden of respiratory disease caused by SHS exposure was estimated in terms of incident cases and hospitalized cases for asthma, OM, and LRI. Estimates were calculated using the population attributable fraction. The age-specific (0-1 year, 0-4 years, 5-11 years, and 0-11 years) prevalence of SHS exposure in children was estimated through a telephone survey performed in a representative sample of Spanish households with children in 2016. The risk estimates for all diseases were selected from international meta-analyses. The number of hospitalized cases was obtained for each disease from the Hospital Minimum Data Set provided by the Ministry of Health of Spain. Incident cases were obtained from the Global Health Data Exchange. In 2015, SHS exposure caused an estimated total of 136,403 incident cases of the following respiratory diseases: 9058 (8.5%) cases of asthma, 120,248 (8.5%) of OM, and 7097 (13.5%) of LRI in children aged 0-14 years old in Spain. Likewise, SHS exposure caused a total of 3028 hospitalized cases, with 379 (8.5%) for asthma and 167 (8.5%) for OM in children 0-11 years old, and 2482 (11.6%) for LRI in children <2 years old. The high burden of respiratory disease attributed to SHS exposure supports the need to improve protection of children against SHS exposure by extending smoke-free regulations to homes and cars.
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Affiliation(s)
- Xavier Continente
- Agència de Salut Pública de Barcelona (Public Health Agency, Barcelona), Pl. Lesseps, 1, PC 08023 Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP) (Biomedical Research Centre Network for Epidemiology and Public Health), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, PC 28029 Madrid, Spain; Institut d'Investigació Biomèdica de Sant Pau (IIB Sant Pau) (Institute of Biomedical Research, Barcelona), Sant Antoni Maria Claret, 167, PC 08025 Barcelona, Spain
| | - Teresa Arechavala
- Agència de Salut Pública de Barcelona (Public Health Agency, Barcelona), Pl. Lesseps, 1, PC 08023 Barcelona, Spain; Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra (UPF) (Experimental and Health Sciences Department, Pompeu Fabra University), Dr. Aiguader, 88, PC 08003 Barcelona, Spain
| | - Esteve Fernàndez
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia (ICO), Granvia de L'Hospitalet, 199-203, PC 08908 L'Hospitalet de Llobregat, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Granvia de L'Hospitalet, 199, PC 08908 L'Hospitalet de Llobregat, Spain; Department of Clinical Sciences, Campus de Bellvitge, School of Medicine and Health Sciences, Universitat de Barcelona, Feixa Llarga, s/n, PC 08907 L'Hospitalet de Llobregat, Spain
| | - Mónica Pérez-Ríos
- Epidemiology Unit, Galician Directorate for Public Health, Galician Health Authority, Xunta de Galicia, San Caetano, s/n, PC 15704 Santiago de Compostela, Spain; Department of Preventive Medicine and Public Health, School of Medicine, University of Santiago de Compostela, Praza do Obradoiro, s/n, PC 15782 Santiago de Compostela, Spain
| | - Anna Schiaffino
- Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Granvia de L'Hospitalet, 199, PC 08908 L'Hospitalet de Llobregat, Spain; Direcció General de Planificació en Salut, Departament de Salut, Generalitat de Catalunya, Travessera de les Corts, 131-159 (Pavelló Ave Maria), PC 08028 Barcelona, Spain
| | - Joan B Soriano
- Fundación para la Investigación Biomédica del Hospital Universitario La Princesa (IISP) (The Biomedical Research Foundation of University Hospital La Princesa), Diego de León, 62 1st floor, PC 28006 Madrid, Spain
| | - Giulia Carreras
- Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO) (Oncological Network, Prevention & Research Institute), Via Cosimo Il Vecchio, 2, PC 50139 Firenze, Italy
| | - Ángel López-Nicolás
- Universidad Politécnica de Cartagena (UPCT) (Polytechnic University of Cartagena), Plaza Cronista Isidoro Valverde, s/n, PC 30202 Cartagena, Spain
| | - Giuseppe Gorini
- Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO) (Oncological Network, Prevention & Research Institute), Via Cosimo Il Vecchio, 2, PC 50139 Firenze, Italy
| | - Maria José López
- Agència de Salut Pública de Barcelona (Public Health Agency, Barcelona), Pl. Lesseps, 1, PC 08023 Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP) (Biomedical Research Centre Network for Epidemiology and Public Health), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, PC 28029 Madrid, Spain; Institut d'Investigació Biomèdica de Sant Pau (IIB Sant Pau) (Institute of Biomedical Research, Barcelona), Sant Antoni Maria Claret, 167, PC 08025 Barcelona, Spain; Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra (UPF) (Experimental and Health Sciences Department, Pompeu Fabra University), Dr. Aiguader, 88, PC 08003 Barcelona, Spain.
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Buters J, Behrendt H, Raulf M. Allergien und Umwelteinflüsse. ALLERGO JOURNAL 2019. [DOI: 10.1007/s15007-019-1835-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Oluwole O, Rennie DC, Senthilselvan A, Dyck R, Afanasieva A, Adamko DJ, Lawson JA. Asthma diagnosis among children along an urban-rural gradient. J Asthma 2018; 55:1242-1252. [PMID: 29420108 DOI: 10.1080/02770903.2017.1407335] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Studies have reported lower asthma prevalence in rural compared to urban areas. While environmental factors have mostly been implicated for these differences, the lower asthma prevalence could also be linked to asthma under-diagnosis in rural children. We investigate if rural children experience under-diagnosis of asthma more compared to urban children. METHODS In 2013, we conducted a cross-sectional survey of schoolchildren across an urban-rural gradient in Saskatchewan, Canada. The participants formed sampling frame for future studies. In 2015, we approached those who gave consent in 2013 for further testing, repeated the survey, and conducted clinical testing. Based on survey responses, children were classified into "no asthma," "at-risk-for-asthma," and "diagnosed asthma." We then classified asthma status as either "no asthma" or "probable asthma" based on a validated asthma algorithm. RESULTS The study population of 335 schoolchildren (aged 7-17 years) comprised of 73.4% from large urban, 13.7% from small urban, and 12.8% from rural areas. Proportion with report of physician-diagnosed asthma was 28.5% (Large urban), 34.8% (Small urban), and 20.9% (Rural). Mean percent predicted FEV1 and FEF25%-75% were lower in rural compared to small urban and large urban children (p < 0.05). Among those not classified as with "diagnosed asthma" by the survey, the algorithm further identified presence of asthma in 5.5% large urban, 8.1% small urban, and 18.8% rural children (p = 0.03). CONCLUSION The study revealed evidence of asthma underdiagnosis in rural areas and further supports the use of objective measures in addition to symptoms history when investigating asthma across urban-rural gradients.
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Affiliation(s)
- Oluwafemi Oluwole
- a Department of Community Health and Epidemiology , University of Saskatchewan , Saskatchewan , Canada.,b Canadian Centre for Health and Safety in Agriculture, College of Medicine , University of Saskatchewan , Saskatoon, Saskatchewan , Canada
| | - Donna C Rennie
- b Canadian Centre for Health and Safety in Agriculture, College of Medicine , University of Saskatchewan , Saskatoon, Saskatchewan , Canada.,c College of Nursing , University of Saskatchewan , Saskatchewan , Canada
| | | | - Roland Dyck
- b Canadian Centre for Health and Safety in Agriculture, College of Medicine , University of Saskatchewan , Saskatoon, Saskatchewan , Canada.,e Department of Medicine, College of Medicine , University of Saskatchewan , Saskatoon, Saskatchewan , Canada
| | - Anna Afanasieva
- b Canadian Centre for Health and Safety in Agriculture, College of Medicine , University of Saskatchewan , Saskatoon, Saskatchewan , Canada
| | - Darryl J Adamko
- f Department of Pediatrics , College of Medicine, University of Saskatchewan , Saskatoon, Saskatchewan , Canada
| | - Joshua A Lawson
- b Canadian Centre for Health and Safety in Agriculture, College of Medicine , University of Saskatchewan , Saskatoon, Saskatchewan , Canada.,e Department of Medicine, College of Medicine , University of Saskatchewan , Saskatoon, Saskatchewan , Canada
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Protano C, Owczarek M, Antonucci A, Guidotti M, Vitali M. Assessing indoor air quality of school environments: transplanted lichen Pseudovernia furfuracea as a new tool for biomonitoring and bioaccumulation. ENVIRONMENTAL MONITORING AND ASSESSMENT 2017; 189:358. [PMID: 28656559 DOI: 10.1007/s10661-017-6076-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 06/15/2017] [Indexed: 06/07/2023]
Abstract
The aim of this research is to evaluate the ability of transplanted lichen Pseudovernia (P). furfuracea to biomonitor and bioaccumulate in urban indoor environments. The elements As, Cd, Cr, Cu, Hg, Ni and Pb and 12 selected polycyclic aromatic hydrocarbons (PAHs) were used to assess P. furfuracea as a biomonitoring tool for the indoor air quality of school environments. To achieve this purpose, lichen samples were exposed for 2 months in the outdoor and indoor environments of five school settings located in urban and rural areas. The results demonstrated that transplanted lichen P. furfuracea is a suitable biomonitoring tool for metals and PAHs in indoor settings and can discriminate between different levels of air pollution related to urbanisation and indoor conditions, such as those characterised by school environments. A transplanted lichen biomonitoring strategy is cost-effective, "green", educational for attending children and less "invasive" than traditional air sampling methods. The feasibility of indoor monitoring by P. furfuracea is a relevant finding and could be a key tool to improve air quality monitoring programmes in school scenarios and thus focus on health prevention interventions for children, who are one of the most susceptible groups in the population.
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Affiliation(s)
- Carmela Protano
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro, 5, 00185, Rome, Italy
| | - Malgorzata Owczarek
- Arpa Lazio, Regional Agency for Environmental Protection, Sede di Rieti, Via Salaria per l'Aquila, 8, 02100, Rieti, Italy
| | - Arianna Antonucci
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro, 5, 00185, Rome, Italy
- Department of Ecological and Biological Sciences, Tuscia University, Via S. Maria in Gradi, 4, 01100, Viterbo, Italy
| | - Maurizio Guidotti
- Arpa Lazio, Regional Agency for Environmental Protection, Sede di Rieti, Via Salaria per l'Aquila, 8, 02100, Rieti, Italy
| | - Matteo Vitali
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro, 5, 00185, Rome, Italy.
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Oluwole O, Kirychuk SP, Lawson JA, Karunanayake C, Cockcroft DW, Willson PJ, Senthilselvan A, Rennie DC. Indoor mold levels and current asthma among school-aged children in Saskatchewan, Canada. INDOOR AIR 2017; 27:311-319. [PMID: 27108895 DOI: 10.1111/ina.12304] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 04/12/2016] [Indexed: 06/05/2023]
Abstract
Current knowledge regarding the association between indoor mold exposures and asthma is still limited. The objective of this case-control study was to investigate the relationship between objectively measured indoor mold levels and current asthma among school-aged children. Parents completed a questionnaire survey of health history and home environmental conditions. Asthma cases had a history of doctor-diagnosed asthma or current wheeze without a cold in the past 12 months. Controls were age- and sex-matched to cases. Vacuumed dust samples were collected from the child's indoor play area and mattress. Samples were assessed for mold levels and quantified in colony-forming units (CFU). Sensitization to mold allergens was also determined by skin testing. Being a case was associated with family history of asthma, pet ownership, and mold allergy. Mold levels (CFU/m2 ) in the dust samples of children's mattress and play area floors were moderately correlated (r = 0.56; P < 0.05). High mold levels (≥30 000 CFU/m2 ) in dust samples from play [adjusted odds ratio (aOR) = 2.6; 95% CI: 1.03-6.43] and mattress (aOR) = 3.0; 95% CI: 1.11-8.00) areas were significantly associated with current asthma. In this study high levels of mold are a risk factor for asthma in children.
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Affiliation(s)
- O Oluwole
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - S P Kirychuk
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - J A Lawson
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - C Karunanayake
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - D W Cockcroft
- Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - P J Willson
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Vaccine and Infectious Disease Organization, University of Saskatchewan, Saskatoon, SK, Canada
| | - A Senthilselvan
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - D C Rennie
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada
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Oluwole O, Arinola GO, Huo D, Olopade CO. Household biomass fuel use, asthma symptoms severity, and asthma underdiagnosis in rural schoolchildren in Nigeria: a cross-sectional observational study. BMC Pulm Med 2017; 17:3. [PMID: 28056916 PMCID: PMC5216579 DOI: 10.1186/s12890-016-0352-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 12/14/2016] [Indexed: 11/26/2022] Open
Abstract
Background In 2014, the International Study of Asthma and Allergies in Childhood (ISAAC) reported that the highest prevalence of symptoms of severe asthma was found in the low- and middle-income countries (LMICs), including Nigeria. While exposure to biomass fuel use may be an important risk factor in the development of asthma, its association with asthma symptoms severity has not been well-established. The aim of this study is to extend the spectrum of environmental risk factors that may be contributing towards increasing asthma morbidity, especially asthma symptoms severity in rural schoolchildren in Nigeria and to examine possible asthma underdiagnosis among this population. Methods Authors conducted a cross-sectional survey in three rural communities in Nigeria. Asthma symptoms were defined according to the ISAAC criteria. Information on the types of household fuel used for cooking was used to determine household cooking fuel status. Asthma symptoms severity was defined based on frequencies of wheeze, day- and night-time symptoms, and speech limitations. Logistic regression analyses were used to explore associations. Results A total of 1,690 Nigerian schoolchildren participated in the study. Overall, 37 (2.2%) had diagnosed asthma and 413 (24.4%) had possible asthma (asthma-related symptoms but not diagnosed asthma). Children from biomass fuel households had higher proportion of possible asthma (27.7 vs. 22.2%; p < 0.05) and symptoms of severe asthma (18.2 vs. 7.6%; p = 0.048). In adjusted analyses, biomass fuel use was associated with increased odds of severe symptoms of asthma [odds ratios (OR) = 2.37; 95% CI: 1.16–4.84], but not with possible asthma (OR = 1.22; 95% CI: 0.95–1.56). Conclusion In rural Nigerian children with asthma symptoms, the use of biomass fuel for cooking is associated with an increased risk of severe asthma symptoms. There is additional evidence that rural children might be underdiagnosed for asthma.
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Affiliation(s)
- Oluwafemi Oluwole
- Department of Community Health and Epidemiology and the Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.,Department of Medicine and The Center for Global Health, University of Chicago, 5841 S Maryland Avenue, MC 6076, Chicago, IL, 60637, USA
| | - Ganiyu O Arinola
- College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Dezheng Huo
- Department of Public Health Science, University of Chicago, Chicago, IL, USA
| | - Christopher O Olopade
- Department of Medicine and The Center for Global Health, University of Chicago, 5841 S Maryland Avenue, MC 6076, Chicago, IL, 60637, USA.
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Oluwole O, Arinola GO, Huo D, Olopade CO. Biomass fuel exposure and asthma symptoms among rural school children in Nigeria. J Asthma 2016; 54:347-356. [PMID: 27589676 DOI: 10.1080/02770903.2016.1227334] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Approximately 70% of rural Nigerian households rely on biomass fuels for cooking. The International Study of Asthma and Allergies in Childhood (ISAAC) estimates the prevalence of current wheeze among children in Nigeria to have risen from 10.7% in 1999 to approximately 20% in 2014. OBJECTIVE To examine the effects of biomass smoke exposure on asthma symptom prevalence in rural children in Nigeria. METHODS We conducted a cross-sectional survey in rural communities in Nigeria. Asthma symptoms were defined according to ISAAC definitions. Biomass smoke exposure was determined by the types of fuel used for cooking. Logistic regression was used to explore associations between biomass smoke and asthma symptoms. RESULTS The study population comprised 1,690 school children, of which 865 lived in households cooking with biomass and 825 lived in households not using biomass. Asthma symptoms were reported in 481 (28.5%) children. Biomass fuel was associated with increased odds of asthma symptoms. Adjusted odds ratios (aORs) were 1.38 (95% CI: 1.05-1.80) for nocturnal cough, 1.26 (95% CI: 1.00-1.61) for current wheeze, and 1.33 (95% CI: 1.05-1.69) for report of any asthma-related symptoms. Sex modified the associations between asthma symptoms with biomass fuel: aORs were stronger and significant for males (nocturnal cough = 1.85, 95% CI: 1.24-2.76; current wheeze = 1.48, 95% CI: 1.03-2.13; report of any asthma-related symptoms = 1.60, 95% CI: 1.12-2.28), but weaker and non-significant for females. CONCLUSION The risk of asthma symptoms related to biomass smoke exposure appears to differ by sex.
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Affiliation(s)
- Oluwafemi Oluwole
- a Community Health and Epidemiology and the Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan , Saskatoon , SK , Canada.,d Department of Medicine and The Center for Global Health , University of Chicago , IL , USA
| | - Ganiyu O Arinola
- b College of Medicine, University of Ibadan , Ibadan , Oyo State , Nigeria
| | - Dezheng Huo
- c Department of Public Health Science , University of Chicago , Chicago , IL , USA
| | - Christopher O Olopade
- d Department of Medicine and The Center for Global Health , University of Chicago , IL , USA
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10
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Parsons MA, Beach J, Senthilselvan A. Association of living in a farming environment with asthma incidence in Canadian children. J Asthma 2016; 54:239-249. [PMID: 27383380 DOI: 10.1080/02770903.2016.1206564] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The objective of this population-based 14-year follow-up study was to examine the effect of living in a farm environment on asthma incidence in children. METHODS A total of 10,941 children of ages 0 to 11 years who were free of asthma and wheeze at the baseline (1994-1995) in the National Longitudinal Survey of Children and Youth were considered in the study. Children's living environment was classified, based on interviewer's observation, into three categories: non-rural, rural non-farming, and farming. An incidence of asthma was obtained from health-professional diagnosed asthma reported either by the person most knowledgeable for children under 15 years or by the children themselves if they were of ages 16 years and over. RESULTS The 14-year cumulative incidence of asthma among children living in farming environments was 10.18%, which was significantly lower than that observed for children living in rural non-farming (13.12%) and non-rural environments (16.50%). After adjusting for age group, number of older siblings, allergy, parental history of asthma, dwelling in need of repairs and SES index, a dose-response relationship was observed with children living in rural non-farming and farming environments having significantly reduced risk of asthma [hazard ratio (HR): 0.77; 95% confidence interval (CI): (0.60, 1.00); p = 0.047 and HR: 0.56; 95% CI: (0.41,0.77); p < 0.001] in comparison to those living in non-rural environments. CONCLUSION This cohort study provides further evidence that living in a farming environment during childhood is protective of asthma incidence in adolescence and adulthood and this finding provides further support for the hygiene hypothesis.
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Affiliation(s)
- Marc A Parsons
- a School of Public Health, University of Alberta , Edmonton , Alberta , Canada
| | - Jeremy Beach
- b Division of Preventive Medicine, Department of Medicine, University of Alberta , Edmonton , Alberta , Canada
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11
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Ahumada V, García E, Dennis R, Rojas MX, Rondón MA, Pérez A, Peñaranda A, Barragán AM, Jimenez S, Kennedy MW, Caraballo L. IgE responses to Ascaris and mite tropomyosins are risk factors for asthma. Clin Exp Allergy 2016; 45:1189-200. [PMID: 25702830 DOI: 10.1111/cea.12513] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 02/06/2015] [Accepted: 02/09/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The relationship between helminthiases and allergy is a matter of considerable interest and research. In the tropics, house dust mite exposure, a known risk factor for asthma, is frequently concurrent with helminth infections. It remains to be defined whether infection with the common roundworm Ascaris or its bystander immunological effects influence the prevalence and pathogenesis of asthma independently of mite sensitization. OBJECTIVE To investigate the relationship between the IgE responses to Ascaris and its purified allergens and the risk of asthma in a tropical country. METHODS A nested case-control study was performed in 356 subjects who reported current and past asthma symptoms (asthmatics) and 435 controls that had never experienced such symptoms. They were tested for serum levels of total IgE and specific IgE to Ascaris extract, Asc s 1 (ABA-1), Asc l 3 (tropomyosin) and GST (glutathione transferase). In addition, specific IgE to Dermatophagoides pteronyssinus, Blomia tropicalis and their tropomyosins Der p 10 and Blo t 10 was measured. Sensitization was defined as a positive specific IgE result to any extract or recombinant allergen. RESULTS Sensitization to Ascaris and D. pteronyssinus was independently associated with asthma after adjustment for age, gender, socio-economic stratum, city and other IgE levels (adjusted ORs: 2.17; 95% CI 1.37-3.42 and 2.46; 95% CI 1.54-3.92), respectively. There was also a significant association with sensitization to the highly allergenic and cross-reactive tropomyosins Asc l 3, Blo t 10 and Der p10 (aORs: 1.76; 95% CI 1.21-2.57, 1.64; 95% CI 1.14-2.35 and 1.51; 95% CI 1.02-2.24), respectively. CONCLUSION AND CLINICAL RELEVANCE IgE responses to Ascaris are associated with asthma symptoms in a population living in the tropics. Sensitization to the cross-reactive Ascaris and mite tropomyosins partially underlies this finding. These results have potential relevance in asthma diagnosis and management.
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Affiliation(s)
- V Ahumada
- Institute for Immunological Research, University of Cartagena, Cartagena, Colombia
| | - E García
- Division of Pediatric Allergy and Otorhinolaryngology, Fundación Santafé de Bogotá, Bogotá, Colombia
| | - R Dennis
- Research Department, Fundación Cardioinfantil - Instituto de Cardiología, Bogotá, Colombia.,Department of Clinical Epidemiology and Biostatistics, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - M X Rojas
- Department of Clinical Epidemiology and Biostatistics, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - M A Rondón
- Department of Clinical Epidemiology and Biostatistics, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - A Pérez
- Division of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA.,Michael & Susan Dell Center for Healthy Living, Austin, TX, USA
| | - A Peñaranda
- Division of Pediatric Allergy and Otorhinolaryngology, Fundación Santafé de Bogotá, Bogotá, Colombia
| | - A M Barragán
- Research Department, Fundación Cardioinfantil - Instituto de Cardiología, Bogotá, Colombia.,Health Sciences Research Center (CICS), Universidad del Rosario, Bogotá, Colombia
| | - S Jimenez
- Institute for Immunological Research, University of Cartagena, Cartagena, Colombia.,Foundation for the Development of Medical and Biological Sciences (Fundemeb), Cartagena, Colombia
| | - M W Kennedy
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK.,Institute of Molecular, Cell and Systems Biology, University of Glasgow, Glasgow, UK
| | - L Caraballo
- Institute for Immunological Research, University of Cartagena, Cartagena, Colombia.,Foundation for the Development of Medical and Biological Sciences (Fundemeb), Cartagena, Colombia
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12
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Sikdar KC, Walsh SJ, Roche M, Jiang Y, Syrowatka A, Collins KD. Diabetes and sex-specific colorectal cancer risks in Newfoundland and Labrador: a population-based retrospective cohort study. Canadian Journal of Public Health 2013. [PMID: 23618197 DOI: 10.1007/bf03405668] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Studies on the relationship between diabetes and colorectal cancer (CRC) are inconsistent. It is also unclear whether CRC risk elevation for individuals with diabetes is similar for males and females. Using data from Newfoundland and Labrador (NL), the province with the highest CRC incidence and diabetes prevalence in Canada, we assessed and compared the risk elevation of CRC for males and females with diabetes, overall and by anatomic subsite. METHODS A population-based retrospective cohort study including a study sample of 122,228 individuals aged ≥30 years was conducted using administrative health databases over a 10.5-year period (October 1, 1996 to March 31, 2007). Hazard ratios were estimated using Cox proportional hazard models. RESULTS In comparison with non-diabetes counterparts, both males and females with diabetes were at a significantly elevated risk of overall CRC, with corresponding hazard ratios of 1.38 and 1.52, respectively. For males, diabetes significantly increased the risk of proximal and distal colon cancers, but not of rectal cancer. For females, diabetes significantly increased the risk of proximal colon and rectal cancers, but not of distal colon cancer. The results suggest that there is a stronger association between diabetes and CRC for females than for males, and the association did not change after adjusting for overweight/obesity. CONCLUSIONS Diabetes led to a greater risk of CRC in both the male and female population in NL. Risk was subsite-specific and varied by sex. Future research should examine reasons for the observed diabetes-associated CRC risk to support CRC prevention strategies among the diabetes population.
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Affiliation(s)
- Khokan C Sikdar
- School of Public Health, University of Alberta, Edmonton, AB.
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