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Rufo JC, Annesi-Maesano I, Carreiro-Martins P, Moreira A, Sousa AC, Pastorinho MR, Neuparth N, Taborda-Barata L. Issue 2 - "Update on adverse respiratory effects of indoor air pollution" Part 1): Indoor air pollution and respiratory diseases: A general update and a Portuguese perspective. Pulmonology 2024; 30:378-389. [PMID: 37230882 DOI: 10.1016/j.pulmoe.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE To quantify the impact of different air pollutants on respiratory health based on robust estimates based on international data and to summarise the evidence of associations between indoor exposure to those pollutants and respiratory morbidity in the Portuguese population. RESULTS Several systematic reviews and meta-analyses (MA) at the world level demonstrate the impact of indoor air quality on respiratory health, with indoor particulate matter and gasses exerting a significant effect on the airways. Volatile organic compounds (VOC) have been related to asthma and lung cancer. However, only meta-analyses on biomass use allowed documentation of long-term respiratory effects. While early publications concerning Portuguese-based populations mainly focused on indoor exposure to environmental tobacco smoke, later studies relocated the attention to relevant exposure environments, such as day care buildings, schools, residences and nursing homes. Looking at the pooled effects from the reviewed studies, high levels of carbon dioxide and particulate matter in Portuguese buildings were significantly associated with asthma and wheezing, with VOC and fungi showing a similar effect in some instances. CONCLUSIONS Despite the significant reduction of indoor air pollution effects after the 2008 indoor smoking prohibition in public buildings, studies show that several indoor air parameters are still significantly associated with respiratory health in Portugal. The country shares the worldwide necessity of standardisation of methods and contextual data to increase the reach of epidemiological studies on household air pollution, allowing a weighted evaluation of interventions and policies focused on reducing the associated respiratory morbidity.
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Affiliation(s)
- J C Rufo
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal
| | - I Annesi-Maesano
- Institute Desbrest of Epidemiology and Public Health, University of Montpellier and INSERM, Montpellier, France
| | - P Carreiro-Martins
- Comprehensive Health Research Center (CHRC), NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisboa, Portugal; Immunoallergology Service, Dona Estefânia Hospital, Centro Hospitalar e Universitário de Lisboa Central (CHULC), Lisbon, Portugal.
| | - A Moreira
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal; Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, Porto, Portugal; Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - A C Sousa
- Comprehensive Health Research Centre (CHRC) and Department of Biology, University of Évora, Évora, Portugal; NuESA-Health and Environment Study Unit, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - M R Pastorinho
- NuESA-Health and Environment Study Unit, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal; Comprehensive Health Research Centre (CHRC) and Department of Medical and Health Sciences, University of Évora, Évora, Portugal
| | - N Neuparth
- Comprehensive Health Research Center (CHRC), NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisboa, Portugal; Immunoallergology Service, Dona Estefânia Hospital, Centro Hospitalar e Universitário de Lisboa Central (CHULC), Lisbon, Portugal
| | - L Taborda-Barata
- NuESA-Health and Environment Study Unit, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal; UBIAir-Clinical & Experimental Lung Centre, University of Beira Interior, CACB - Clinical Academic Centre of Beiras, Covilhã, Portugal; CICS-Health Sciences Research Centre, University of Beira Interior, CACB - Clinical Academic Centre of Beiras, Covilhã, Portugal; Immunoallergology Service, Centro Hospitalar Universitário Cova da Beira, CACB - Clinical Academic Centre of Beiras, Covilhã, Portugal
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Li X, Guo D, Zhou W, Hu Y, Zhou H, Chen Y. Oxidative Stress and Inflammation Markers Associated with Multiple Peripheral Artery Occlusions in Elderly Patients. Angiology 2022; 74:472-487. [PMID: 35786005 DOI: 10.1177/00033197221111860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Pro-oxidative stress and pro-inflammatory responses can influence each other in the development of atherosclerosis. This study evaluated the relationship between oxidative stress, inflammation, and multiple peripheral artery occlusions in elderly patients (age mean 71.2 ± 8.1 years). Methods: A total of 723 participants were enrolled: 67 healthy subjects, 214 patients with common iliac artery occlusions, 224 patients with popliteal artery occlusions, and 218 patients with femoral artery occlusions. We measured oxidative stress biomarkers (malondialdehyde [MDA], F2-isoprostane [F2-isoP], total oxidant status [TOS], and ischemia-modified albumin [IMA]) and the expressions of molecules in mimecan (MIME)/nuclear factor kappa B (NF-κB)/P53/Toll-like receptor 4 (TLR4) signaling pathway in older patients with multiple peripheral artery occlusions. Results: The levels of MDA, F2-isoP, TOS, IMA, MIME, NF-κB, P53, and TLR4 were increased in the single-site peripheral artery occlusive group when compared with healthy controls (P < .001) and were further increased in the multiple-site peripheral artery occlusive group compared with the single-site peripheral artery occlusive group (P < .001). Conclusion: Oxidative stress may promote inflammatory signaling pathways and lead to multiple peripheral artery occlusions in elderly patients.
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Affiliation(s)
- Xia Li
- Xiamen Road Branch Hospital, 38044The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian, China
| | - Dianxuan Guo
- Xiamen Road Branch Hospital, 38044The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian, China
| | - Wenhang Zhou
- Xiamen Road Branch Hospital, 38044The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian, China
| | - Youdong Hu
- Xiamen Road Branch Hospital, 38044The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian, China
| | - Hualan Zhou
- Xiamen Road Branch Hospital, 38044The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian, China
| | - Ying Chen
- Xiamen Road Branch Hospital, 38044The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian, China
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Alves J, Filipe R, Machado J, Nunes B, Perelman J. Change in the Prevalence and Social Patterning of First-and Second-Hand Smoking in PORTUGAL: A Repeated Cross-Sectional Study (2005 and 2014). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103594. [PMID: 32443801 PMCID: PMC7277527 DOI: 10.3390/ijerph17103594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 11/16/2022]
Abstract
Between 2005 and 2007, important reinforcements of the tobacco legislation have been implemented in Portugal, which may have affected smoking patterns. The aim of this study was to measure the change in prevalence of first- and second-hand smoking (SHS) among adults, and its socio-demographic patterning in Portugal from 2005 to 2014. Data from the last two Portuguese National Health Interview Surveys (2005 and 2014) were used. The changes in daily smoking and SHS were measured using Poisson regressions, stratifying by sex and survey year. The inequalities were measured using relative inequality indexes (RII). From 2005 to 2014, there was a reduction in SHS (75%-54% among men, and 52%-38% among women), and a reduction in smoking among men (27%-26%), and an increase among women (9%-12%). SHS reduction was more marked among less privileged people. Among Portuguese men, inequalities in daily smoking have increased slightly, while among women the gap favoring low-educated reduced. Between 2005 and 2014, SHS decreased, but not daily smoking, particularly among women. Additionally, socioeconomic inequalities in smoking increased. Future policies should simultaneously tackle smoking and SHS prevalence, and their socioeconomic patterning. More comprehensive policies such as comprehensive national (non-partial) bans, combined with price increases could be more effective.
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Affiliation(s)
- Joana Alves
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, 1600-560 Lisboa, Portugal;
- Correspondence: ; Tel.: +351 217 512 186
| | - Rita Filipe
- ACES Lisboa Ocidental e Oeiras—Public Health Unit, 2780-163 Oeiras, Portugal;
| | - João Machado
- Department of Epidemiology, Instituto Nacional de Saúde Dr. Ricardo Jorge, 1649-016 Lisboa, Portugal; (J.M.); (B.N.)
| | - Baltazar Nunes
- Department of Epidemiology, Instituto Nacional de Saúde Dr. Ricardo Jorge, 1649-016 Lisboa, Portugal; (J.M.); (B.N.)
| | - Julian Perelman
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, 1600-560 Lisboa, Portugal;
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Pereira AM. Smoking in Portugal: Where do we stand today? Rev Port Cardiol 2019; 38:595-597. [PMID: 31703972 DOI: 10.1016/j.repc.2019.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Ana Margarida Pereira
- CINTESIS, Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Portugal; Allergy Unit, CUF-Porto Instituto & Hospital, Porto, Portugal; MEDCIDS-Department of Community Medicine, Information, and Health Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.
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Pereira AM. Smoking in Portugal: Where do we stand today? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2019.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Costa A, Cortes M, Sena C, Nunes E, Nogueira P, Shivaji T. Equity-focused health impact assessment of Portuguese tobacco control legislation. Health Promot Int 2018; 33:279-287. [PMID: 27694228 DOI: 10.1093/heapro/daw076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The World Health Organization recommend the Equity-Focused Health Impact Assessment (HIA) as a means to assess the impact of social and economic policies on the health of populations, and acknowledges their contribution to health inequality. We describe the application of the Equity-focused Impact Assessment methodology on the Portuguese law on Smoking Prevention and Tobacco Control (Law No. 37/2007). A rapid assessment was carried out to issue recommendations which could be incorporated into the law during a revision in 2014. Quantitative (consumption and health status indicators; equity analysis) and qualitative (Focus Group) approaches were taken to evaluate the impact of the law and formulate recommendations. Young people, men and women of low socioeconomic status, and pregnant women were identified as requiring specific and appropriate interventions to prevent smoking and support smoking cessation.
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Affiliation(s)
- A Costa
- Directorate of Disease Prevention and Health Promotion, Directorate-General of Health, Ministry of Health, Lisbon, Portugal
| | - M Cortes
- Directorate of Disease Prevention and Health Promotion, Directorate-General of Health, Ministry of Health, Lisbon, Portugal
| | - C Sena
- Directorate of Disease Prevention and Health Promotion, Directorate-General of Health, Ministry of Health, Lisbon, Portugal
| | - E Nunes
- Directorate of Disease Prevention and Health Promotion, Directorate-General of Health, Ministry of Health, Lisbon, Portugal
| | - P Nogueira
- Directorate of Disease Prevention and Health Promotion, Directorate-General of Health, Ministry of Health, Lisbon, Portugal
| | - T Shivaji
- Directorate of Disease Prevention and Health Promotion, Directorate-General of Health, Ministry of Health, Lisbon, Portugal
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Araújo D, Padrão E, Morais-Almeida M, Cardoso J, Pavão F, Leite RB, Caldas AC, Marques A. Asthma-chronic obstructive pulmonary disease overlap syndrome - Literature review and contributions towards a Portuguese consensus. REVISTA PORTUGUESA DE PNEUMOLOGIA 2017; 23:90-99. [PMID: 28089081 DOI: 10.1016/j.rppnen.2016.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 11/05/2016] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Phenotypic overlap between the two main chronic airway pulmonary diseases, asthma and chronic obstructive pulmonary disease (COPD), has been the subject of debate for decades, and recently the nomenclature of asthma-COPD overlap syndrome (ACOS) was adopted for this condition. The definition of this entity in the literature is, however, very heterogeneous, it is therefore important to define how it applies to Portugal. METHODS A literature review of ACOS was made in a first phase resulting in the drawing up of a document that was later submitted for discussion among a panel of chronic lung diseases experts, resulting in reflexions about diagnosis, treatment and clinical guidance for ACOS patients. RESULTS There was a consensus among the experts that the diagnosis of ACOS should be considered in the concomitant presence of: clinical manifestations characteristic of both asthma and COPD, persistent airway obstruction (post-bronchodilator FEV1/FVC<0.7), positive response to bronchodilator test (increase in FEV1 of ≥200mL and ≥12% from baseline) and current or past history of smoking or biomass exposure. In reaching diagnosis, the presence of peripheral eosinophilia (>300eosinophils/μL or >5% of leukocytes) and previous history of atopy should also be considered. The recommended first line pharmacological treatment in these patients is the ICS/LABA association; if symptomatic control is not achieved or in case of clinical severity, triple therapy with ICS/LABA/LAMA may be used. An effective control of the exposure to risk factors, vaccination, respiratory rehabilitation and treatment of comorbidities is also important. CONCLUSIONS The creation of initial guidelines on ACOS, which can be applied in the Portuguese context, has an important role in the generation of a broad nationwide consensus. This will give, in the near future, a far better clinical, functional and epidemiological characterization of ACOS patients, with the ultimate goal of achieving better therapeutic guidance.
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Affiliation(s)
- D Araújo
- Institute of Health Sciences, Universidade Católica Portuguesa, Portugal; Pulmonology Department, Centro Hospitalar de São João, Porto, Portugal
| | - E Padrão
- Institute of Health Sciences, Universidade Católica Portuguesa, Portugal; Pulmonology Department, Centro Hospitalar de São João, Porto, Portugal.
| | - M Morais-Almeida
- Coordinator of Allergy Center of CUF Hospitals, Lisbon, Portugal
| | - J Cardoso
- Pulmonology Department, Centro Hospitalar de Lisboa Central, Lisboa, Portugal; Nova Medical School, Lisbon, Portugal
| | - F Pavão
- Institute of Health Sciences, Universidade Católica Portuguesa, Portugal
| | - R B Leite
- Institute of Health Sciences, Universidade Católica Portuguesa, Portugal; Faculty of Health, Medicine and Life Sciences, Maastricht University, Portugal
| | - A C Caldas
- Institute of Health Sciences, Universidade Católica Portuguesa, Portugal
| | - A Marques
- Pulmonology Department, Centro Hospitalar de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Portugal
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