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Li W, Long C, Fan T, Anneser E, Chien J, Goodman JE. Gas cooking and respiratory outcomes in children: A systematic review. GLOBAL EPIDEMIOLOGY 2023; 5:100107. [PMID: 37638371 PMCID: PMC10446006 DOI: 10.1016/j.gloepi.2023.100107] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 08/29/2023] Open
Abstract
The most recent meta-analysis of gas cooking and respiratory outcomes in children was conducted by Lin et al. [93] in 2013. Since then, a number of epidemiology studies have been published on this topic. We conducted the first systematic review of this epidemiology literature that includes an in-depth evaluation of study heterogeneity and study quality, neither of which was systematically evaluated in earlier reviews. We reviewed a total of 66 relevant studies, including those in the Lin et al. [93] meta-analysis. Most of the studies are cross-sectional by design, precluding causal inference. Only a few are cohort studies that could establish temporality and they have largely reported null results. There is large variability across studies in terms of study region, age of children, gas cooking exposure definition, and asthma or wheeze outcome definition, precluding clear interpretations of meta-analysis estimates such as those reported in Lin et al. [93]. Further, our systematic study quality evaluation reveals that a large proportion of the studies to date are subject to multiple sources of bias and inaccuracy, primarily due to self-reported gas cooking exposure or respiratory outcomes, insufficient adjustment for key confounders (e.g., environmental tobacco smoke, family history of asthma or allergies, socioeconomic status or home environment), and unestablished temporality. We conclude that the epidemiology literature is limited by high heterogeneity and low study quality and, therefore, it does not provide sufficient evidence regarding causal relationships between gas cooking or indoor NO2 and asthma or wheeze. We caution against over-interpreting the quantitative evidence synthesis estimates from meta-analyses of these studies.
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Affiliation(s)
- Wenchao Li
- Gradient, One Beacon St., 17 Floor, Boston, MA 02108, United States of America
| | - Christopher Long
- Gradient, One Beacon St., 17 Floor, Boston, MA 02108, United States of America
| | - Tongyao Fan
- Penn State College of Medicine, Department of Pharmacology, 500 University Drive, Hershey, PA 17033, United States of America
| | - Elyssa Anneser
- Gradient, One Beacon St., 17 Floor, Boston, MA 02108, United States of America
| | - Jiayang Chien
- Gradient, One Beacon St., 17 Floor, Boston, MA 02108, United States of America
| | - Julie E. Goodman
- Gradient, One Beacon St., 17 Floor, Boston, MA 02108, United States of America
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Xue Q, Zou M, Guo J, Teng Q, Zhang Q, Sheng L, Xu S, Fang C, Yao N, Li Y, Zhao J. Detection and assessment of dust mite allergens in an indoor environment in Anhui, China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:3045-3055. [PMID: 35941504 PMCID: PMC9892137 DOI: 10.1007/s11356-022-22395-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 08/01/2022] [Indexed: 06/15/2023]
Abstract
Dust in the home environment is thought to be a potential trigger for increasing allergic diseases, such as allergic rash, rhinitis, asthma, and other conditions, associated with dust mites. To verify the status of dust mite prevalence in indoor surroundings, we collected 189 dust samples from the air conditioner filters (n = 75) and floors (n = 114) of households, schools, and hotels in the Anhui area, China. All samples were measured for dust mite breeding rate and breeding density under light microscopy and analyzed for dust mite species Dermatophagoides farinae 1 (Der f 1) and Dermatophagoides pteronyssinus 1 (Der p 1) allergen using enzyme-linked immunosorbent assay (ELISA). The dust mite breeding rates were 34.67% (26/75) and 20.18% (23/114), respectively, in the dust samples from the floor and air conditioning filters. The breeding density was the highest in households (10/g), followed by schools (9/g) and hotels (4/g). ELISA indicated that the allergen threshold (2.0 µg/g dust) of Der f 1 was exceeded in only two samples and Der p 1 in one sample. Additionally, a questionnaire was used to investigate the health knowledge on allergic diseases involved in indoor facilities, finding that most allergy sufferers were aware that indoor dust might be responsible for their conditions. The findings suggest that regular maintenance of indoor hygiene and cleaning of air-conditioning filters should reduce the risks of exposure to indoor allergens.
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Affiliation(s)
- Qiqi Xue
- Department of Medical Parasitology, Wannan Medical College, WuhuAnhui, 241002, China
| | - Minghui Zou
- Department of Medical Parasitology, Wannan Medical College, WuhuAnhui, 241002, China
| | - Junjie Guo
- Department of Medical Parasitology, Qiqihar Medical College, QiqiharHeilongjiang, 161000, China
| | - Qiao Teng
- Department of Medical Parasitology, Wannan Medical College, WuhuAnhui, 241002, China
| | - Qiqi Zhang
- School of Clinical Medicine, Wannan Medical College, WuhuAnhui, 241002, China
| | - Lingwei Sheng
- Medical Laboratory Science, Wannan Medical College, WuhuAnhui, 241002, China
| | - Sijia Xu
- Medical Laboratory Science, Wannan Medical College, WuhuAnhui, 241002, China
| | - Can Fang
- School of Public Health, Wannan Medical College, WuhuAnhui, 241002, China
| | - Ning Yao
- School of Public Health, Wannan Medical College, WuhuAnhui, 241002, China
| | - Yuanyuan Li
- Department of Medical Parasitology, Wannan Medical College, WuhuAnhui, 241002, China
| | - Jinhong Zhao
- Department of Medical Parasitology, Wannan Medical College, WuhuAnhui, 241002, China.
- Anhui Province Key Laboratory of Biological Macromlecules Research, Wannan Medical College, WuhuAnhui, 241002, China.
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Johnston JD, Cowger AE, Weber KS. Bioaerosol and microbial exposures from residential evaporative coolers and their potential health outcomes: A review. INDOOR AIR 2022; 32:e13082. [PMID: 36168234 PMCID: PMC9826010 DOI: 10.1111/ina.13082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 06/10/2022] [Accepted: 07/08/2022] [Indexed: 06/16/2023]
Abstract
Evaporative cooling is an energy efficient form of air conditioning in dry climates that functions by pulling hot, dry outdoor air across a wet evaporative pad. While evaporative coolers can help save energy, they also have the potential to influence human health. Studies have shown residential evaporative coolers may pull outdoor air pollutants into the home or contribute to elevated levels of indoor bioaerosols that may be harmful to health. There is also evidence that evaporative coolers can enable a diverse microbial environment that may confer early-life immunological protection against the development of allergies and asthma or exacerbate these same hypersensitivities. This review summarizes the current knowledge of bioaerosol and microbiological studies associated with evaporative coolers, focusing on harmful and potentially helpful outcomes from their use. We evaluate the effects of evaporative coolers on indoor bacterial endotoxins, fungal β-(1 → 3)-D-glucans, dust mite antigens, residential microbial communities, and Legionella pneumophila. To our knowledge, this is the first review to summarize and evaluate studies on the influence that evaporative coolers have on the bioaerosol and microbiological profile of homes. This brings to light a gap in the literature on evaporative coolers, which is the lack of data on health effects associated with their use.
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Affiliation(s)
| | | | - K. Scott Weber
- Department of Microbiology & Molecular BiologyBrigham Young UniversityProvoUtahUSA
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Shahunja KM, Sly PD, Chisti MJ, Mamun A. Trajectories of asthma symptom presenting as wheezing and their associations with family environmental factors among children in Australia: evidence from a national birth cohort study. BMJ Open 2022; 12:e059830. [PMID: 35667731 PMCID: PMC9185592 DOI: 10.1136/bmjopen-2021-059830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Asthma is one of the greatest health burdens, yet contributors to asthma symptom trajectories are understudied in Australian children. We aimed to assess the trajectories of asthma symptom and their associations with several family environmental factors during the childhood period in Australia. DESIGN Secondary analysis from a cross-sequential cohort study. SETTING Nationwide representative data from the 'Longitudinal Study of Australian Children (LSAC)'. PARTICIPANTS Participants from the LSAC birth cohort. OUTCOME MEASURES Asthma symptom trajectory groups. METHODS Asthma symptom presenting as wheezing, family environmental factors and sociodemographic data (2004-2018) were obtained from the LSAC. Group-based trajectory modelling was applied to identify asthma symptom trajectories and multivariable logistic regression models were used to assess the associations between these and environmental factors. RESULTS Of 5107 children in the LSAC cohort, 3846 were included in our final analysis. We identified three distinct asthma symptom trajectories from age 0/1 year to 14/15 years: 'low/no' (69%), 'transient high' (17%) and 'persistent high' (14%). Compared with the 'low/no' group, children exposed to 'moderate and declining' (relative risk ratio (RRR): 2.22, 95% CI 1.94 to 2.54; RRR: 1.26, 95% CI 1.08 to 1.46) and 'high and persistent' prevalence of maternal smoking (RRR: 1.41, 95% CI 1.23 to 1.60; RRR: 1.26, 95% CI 1.10 to 1.44) were at increased risk of being classified into the 'transient high' and 'persistent high' trajectories of asthma symptom. Persistently bad external dwelling conditions (RRR: 1.27, 95% CI 1.07 to 1.51) were associated with 'transient high' trajectory while 'moderate and increasing' conditions of cluttered homes (RRR: 1.37, 95% CI 1.20 to 1.56) were associated with 'persistent high' trajectory of asthma symptom. Exposure to tobacco smoke inside the house also increased the risk of being in the 'persistent high' trajectory group (RRR: 1.30, 95% CI 1.12 to 1.50). CONCLUSION Poor home environment increased the risk of asthma symptom during childhood. Improving home environment and reducing exposure to tobacco smoke may facilitate a favourable asthma symptom trajectory during childhood.
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Affiliation(s)
- K M Shahunja
- Institute for Social Science Research, The University of Queensland, Saint Lucia, Queensland, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Queensland, Australia
- The Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Brisbane, Queensland, Australia
| | - Peter D Sly
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Md Jobayer Chisti
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abdullah Mamun
- Institute for Social Science Research, The University of Queensland, Saint Lucia, Queensland, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Queensland, Australia
- The Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Brisbane, Queensland, Australia
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Gray-Ffrench M, Fernandes RM, Sinha IP, Abrams EM. Allergen Management in Children with Type 2-High Asthma. J Asthma Allergy 2022; 15:381-394. [PMID: 35378923 PMCID: PMC8976481 DOI: 10.2147/jaa.s276994] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/17/2022] [Indexed: 11/30/2022] Open
Abstract
Children exposed to various indoor and outdoor allergens are placed at an increased risk of developing asthma in later life, with sensitization in these individuals being a strong predictor of disease morbidity. In addition, aeroallergen exposure influences asthma outcomes through an interplay with adverse determinants of health. The goal of this review is to provide an introductory overview of factors related to aeroallergen exposure in type 2-high childhood asthma. These include the relevance of exposure in asthma exacerbations and severity, and the evidence-base for avoidance and treatment for sensitization to these allergens. This review will focus on both indoor aeroallergens (house dust mite, pet, cockroach, mold, and rodent) and outdoor aeroallergens (pollens and molds). Treatment of aeroallergen sensitization in children with asthma includes avoidance and removal measures, although there is limited evidence of clinical benefit especially with single-strategy approaches. We will also address the interplay of aeroallergens and climate change, adverse social determinants, and the current COVID-19 pandemic, when we have seen a dramatic reduction in asthma exacerbations and emergency department visits among children. While there are many factors that are hypothesized to contribute to this reduction, among them is a reduced exposure to outdoor seasonal aeroallergens.
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Affiliation(s)
| | - Ricardo M Fernandes
- Clinical Pharmacology Unit, Faculty of Medicine and Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal
- Department of Pediatrics, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
| | - Ian P Sinha
- Alder Hey Children’s Hospital, Liverpool, UK
- Department of Women’s and Children’s Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Canada
- Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, British Columbia, Canada
- Correspondence: Elissa M Abrams, Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, FE125-685 William Avenue, Winnipeg, MB, R2A 5L9, Canada, Tel +1 204-255-7650, Fax +1 204-254-0730, Email
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Shahunja KM, Sly PD, Begum T, Biswas T, Mamun A. Family, neighborhood and psychosocial environmental factors and their associations with asthma in Australia: a systematic review and Meta-analysis. J Asthma 2021; 59:2539-2552. [PMID: 34905415 DOI: 10.1080/02770903.2021.2018707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Various associations between different environmental exposures and asthma have been reported in different countries and populations. We aimed to investigate the associations between family, neighborhood and psychosocial environmental factors and asthma-symptoms in Australia by conducting a systematic review and meta-analysis. DATA SOURCES We analyzed the primary research studies conducted in Australia across multiple databases, including PubMed, EMBASE and Scopus, published between 2000 and 2020. STUDY SELECTIONS The reviews and analyses focused on the overall association of different environmental exposures with the exacerbation of asthma-symptoms or asthma-related hospital visits. Quality-effect meta-analysis was done to estimate the pooled odds ratio for different environmental exposures for asthma-symptoms. RESULTS Among the 4799 unique published articles found, 46 were included here for systematic review and 28 for meta-analysis. Our review found that psychosocial factors, including low socioeconomic condition, maternal depression, mental stress, ethnicity, and discrimination, are associated with asthma-symptoms. Pooled analysis was conducted on family and neighborhood environmental factors and revealed that environmental tobacco smoking (ETS) (OR 1·69, 95% CI 1·19-2·38), synthetic bedding (OR 1·91, 95% CI 1·48-2·47) and gas heaters (OR 1·40, 95% CI 1·12-1·76) had significant overall associations with asthma-symptoms in Australia. CONCLUSION Although the studies were heterogeneous, both systematic review and meta-analysis found several psychosocial and family environmental exposures significantly associated with asthma-symptoms. Further study to identify their causal relationship and modification may reduce asthma-symptoms in the Australian population.
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Affiliation(s)
- K M Shahunja
- Institute for Social Science Research, The University of Queensland, Brisbane, Australia.,ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Australia.,The Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Brisbane, Australia
| | - Peter D Sly
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Tahmina Begum
- Institute for Social Science Research, The University of Queensland, Brisbane, Australia.,ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Australia
| | - Tuhin Biswas
- Institute for Social Science Research, The University of Queensland, Brisbane, Australia.,ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Australia
| | - Abdullah Mamun
- Institute for Social Science Research, The University of Queensland, Brisbane, Australia.,ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Australia.,The Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Brisbane, Australia
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Wispriyono B, Jalaludin J, Kusnoputranto H, Pakpahan S, Aryati GP, Pratama S, Librianty N, Rozaliyani A, Taufik FF, Novirsa R. Glutathione (GSH) and superoxide dismutase (SOD) levels among junior high school students induced by indoor particulate matter 2.5 (PM2.5) and nitrogen dioxide (NO2) exposure. J Public Health Res 2021; 10. [PMID: 34351097 PMCID: PMC8764553 DOI: 10.4081/jphr.2021.2372] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/06/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Indoor air pollution has globally known as the risk factor of acute respiratory infection in young children. The exposure to indoor particulate matter 2.5 (PM2.5) and nitrogen dioxide (NO2) at house or school can be a potential risk to children's health. This study aimed to examine the association between indoor PM2.5 and NO2 with oxidative stress markers in junior high school students. DESIGN AND METHOD This study was conducted using a cross sectional study with 75 students collected randomly from four junior high schools in Jakarta. PM2.5 and NO2 were measured in classrooms and school yards. The schools were categorized based on the exposure level of PM2.5 and NO2 in classrooms. Superoxide dismutase (SOD) and reduced glutathione (GSH) were examined from the blood sample. All students were interviewed with questionnaires to determine upper respiratory tract infection, smoking family members, mosquito repellent usage, and dietary supplement consumption. RESULTS Mean concentration of indoor PM2.5 and NO2 were 0.125±0.036 mg m-3 and 36.37±22.33 µg m-3, respectively. The schools which located near to highway showed lower PM2.5 and higher NO2 level indicated the emission of traffic activity. Mean activity of SOD was 96.36±50.94 U mL-1 and mean concentration of GSH was of 0.62±0.09 µg mL-1. Most of the students reported upper respiratory tract infection history, smoking family member, use mosquito repellent at home, and do not consume dietary supplement. CONCLUSION The level of oxidative stress markers and the exposure categories of classroom PM2.5 and NO2 was not significantly different, however there were significant correlation with cigarette smoke and mosquito repellent at home. Nevertheless, the exposure of indoor PM2.5 and NO2 increased the risk of the exposure to cigarette smoke and mosquito repellent at home. Further study on the air pollution at school and home is needed to affirm association towards student's health and to design strategic control efforts.
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Affiliation(s)
- Bambang Wispriyono
- Department of Environmental Health, Faculty of Public Health, Universitas Indonesia, Depok.
| | - Juliana Jalaludin
- Department of Environmental and Occupational Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor .
| | - Haryoto Kusnoputranto
- Department of Environmental Health, Faculty of Public Health, Universitas Indonesia, Depok.
| | - Sasnila Pakpahan
- Center for Industrial and Environmental Health Studies Faculty of Public Health, Universitas Indonesia, Depok.
| | - Gita Permata Aryati
- Center for Industrial and Environmental Health Studies Faculty of Public Health, Universitas Indonesia, Depok.
| | - Satria Pratama
- Center for Industrial and Environmental Health Studies Faculty of Public Health, Universitas Indonesia, Depok.
| | - Nurfanida Librianty
- Department of Environmental Health, Faculty of Public Health, Universitas Indonesia, Depok.
| | - Anna Rozaliyani
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta.
| | - Feni Fitriani Taufik
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta.
| | - Randy Novirsa
- Department of Environmental Health, Faculty of Public Health, Universitas Indonesia, Depok.
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Johnston JD, Cowger AE, Graul RJ, Nash R, Tueller JA, Hendrickson NR, Robinson DR, Beard JD, Weber KS. Associations between evaporative cooling and dust-mite allergens, endotoxins, and β-(1 → 3)-d-glucans in house dust: A study of low-income homes. INDOOR AIR 2019; 29:1005-1017. [PMID: 31463967 DOI: 10.1111/ina.12600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/22/2019] [Accepted: 08/25/2019] [Indexed: 06/10/2023]
Abstract
Recent work suggests that evaporative coolers increase the level and diversity of bioaerosols, but this association remains understudied in low-income homes. We conducted a cross-sectional study of metropolitan, low-income homes in Utah with evaporative coolers (n = 20) and central air conditioners (n = 28). Dust samples (N = 147) were collected from four locations in each home and analyzed for dust-mite allergens Der p1 and Der f1, endotoxins, and β-(1 → 3)-d-glucans. In all sample locations combined, Der p1 or Der f1 was significantly higher in evaporative cooler versus central air conditioning homes (OR = 2.29, 95% CI = 1.05-4.98). Endotoxin concentration was significantly higher in evaporative cooler versus central air conditioning homes in furniture (geometric mean (GM) = 8.05 vs 2.85 EU/mg, P < .01) and all samples combined (GM = 3.60 vs 1.29 EU/mg, P = .03). β-(1 → 3)-d-glucan concentration and surface loads were significantly higher in evaporative cooler versus central air conditioning homes in all four sample locations and all samples combined (P < .01). Our study suggests that low-income, evaporative cooled homes have higher levels of immunologically important bioaerosols than central air-conditioned homes in dry climates, warranting studies on health implications and other exposed populations.
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Affiliation(s)
- James D Johnston
- Department of Public Health, Brigham Young University, Provo, Utah
| | - Ashlin E Cowger
- Department of Microbiology & Molecular Biology, Brigham Young University, Provo, Utah
| | - Robert J Graul
- Department of Public Health, Brigham Young University, Provo, Utah
| | - Ryan Nash
- Department of Public Health, Brigham Young University, Provo, Utah
| | - Josie A Tueller
- Department of Microbiology & Molecular Biology, Brigham Young University, Provo, Utah
| | | | | | - John D Beard
- Department of Public Health, Brigham Young University, Provo, Utah
| | - K Scott Weber
- Department of Microbiology & Molecular Biology, Brigham Young University, Provo, Utah
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Richtwerte für Stickstoffdioxid (NO2) in der Innenraumluft. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:664-676. [PMID: 30805672 DOI: 10.1007/s00103-019-02891-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Franklin P, Tan M, Hemy N, Hall GL. Maternal Exposure to Indoor Air Pollution and Birth Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1364. [PMID: 30995726 PMCID: PMC6518425 DOI: 10.3390/ijerph16081364] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 04/14/2019] [Indexed: 12/29/2022]
Abstract
There is a growing body of research on the association between ambient air pollution and adverse birth outcomes. However, people in high income countries spend most of their time indoors. Pregnant women spend much of that time at home. The aim of this study was to investigate if indoor air pollutants were associated with poor birth outcomes. Pregnant women were recruited prior to 18 weeks gestation. They completed a housing questionnaire and household chemical use survey. Indoor pollutants, formaldehyde (HCHO), nitrogen dioxide (NO2) and volatile organic compounds (VOCs), were monitored in the women's homes at 34 weeks gestation. Gestational age (GA), birth weight (BW) and length (BL) and head circumference (HC) were collected from birth records. The associations between measured pollutants, and pollution surrogates, were analysed using general linear models, controlling for maternal age, parity, maternal health, and season of birth. Only HCHO was associated with any of the birth outcomes. There was a 0.044 decrease in BW z-score (p = 0.033) and 0.05 decrease in HC z-score (p = 0.06) for each unit increase in HCHO. Although HCHO concentrations were very low, this finding is consistent with other studies of formaldehyde and poor birth outcomes.
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Affiliation(s)
- Peter Franklin
- School of Population and Global Health, Faculty of Health and Medicine Sciences, The University of Western Australia, Crawley, WA 6009, Australia.
| | - Mark Tan
- School of Paediatrics and Child Health, Faculty of Health and Medicine Sciences, The University of Western Australia, Crawley, WA 6009, Australia.
- Telethon Kids Institute, Nedlands, WA 6009, Australia.
| | - Naomi Hemy
- Telethon Kids Institute, Nedlands, WA 6009, Australia.
| | - Graham L Hall
- Telethon Kids Institute, Nedlands, WA 6009, Australia.
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, WA 6102, Australia.
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11
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Gaffin JM, Hauptman M, Petty CR, Sheehan WJ, Lai PS, Wolfson JM, Gold DR, Coull BA, Koutrakis P, Phipatanakul W. Nitrogen dioxide exposure in school classrooms of inner-city children with asthma. J Allergy Clin Immunol 2018; 141:2249-2255.e2. [PMID: 28988796 PMCID: PMC5886827 DOI: 10.1016/j.jaci.2017.08.028] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 06/27/2017] [Accepted: 08/24/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Ambient and home exposure to nitrogen dioxide (NO2) causes asthma symptoms and decreased lung function in children with asthma. Little is known about the health effects of school classroom pollution exposure. OBJECTIVE We aimed to determine the effect of indoor classroom NO2 on lung function and symptoms in inner-city school children with asthma. METHODS Children enrolled in the School Inner-City Asthma Study were followed for 1 academic year. Subjects performed spirometry and had fraction of exhaled nitric oxide values measured twice during the school year at school. Classroom NO2 was collected by means of passive sampling for 1-week periods twice per year, coinciding with lung function testing. Generalized estimating equation models assessed lung function and symptom relationships with the temporally nearest classroom NO2 level. RESULTS The mean NO2 value was 11.1 ppb (range, 4.3-29.7 ppb). In total, exposure data were available for 296 subjects, 188 of whom had complete spirometric data. At greater than a threshold of 8 ppb of NO2 and after adjusting for race and season (spirometry standardized by age, height, and sex), NO2 levels were associated highly with airflow obstruction, such that each 10-ppb increase in NO2 level was associated with a 5% decrease in FEV1/forced vital capacity ratio (β = -0.05; 95% CI, -0.08 to -0.02; P = .01). Percent predicted forced expiratory flow between the 25th and 75th percentile of forced vital capacity was also inversely associated with higher NO2 exposure (β = -22.8; 95% CI, -36.0 to -9.7; P = .01). There was no significant association of NO2 levels with percent predicted FEV1, fraction of exhaled nitric oxide, or asthma symptoms. Additionally, there was no effect modification of atopy on lung function or symptom outcomes. CONCLUSION In children with asthma, indoor classroom NO2 levels can be associated with increased airflow obstruction.
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Affiliation(s)
- Jonathan M Gaffin
- Division of Respiratory Diseases, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Marissa Hauptman
- Harvard Medical School, Boston, Mass; Division of General Pediatrics, Boston Children's Hospital, Boston, Mass
| | - Carter R Petty
- Clinical Research Center, Boston Children's Hospital, Boston, Mass
| | - William J Sheehan
- Harvard Medical School, Boston, Mass; Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass
| | - Peggy S Lai
- Harvard Medical School, Boston, Mass; Massachusetts General Hospital, Boston, Mass; Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Mass
| | - Jack M Wolfson
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Mass
| | - Diane R Gold
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Mass; Channing Institute of Network Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Brent A Coull
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Mass
| | - Petros Koutrakis
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Mass
| | - Wanda Phipatanakul
- Harvard Medical School, Boston, Mass; Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass.
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12
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Paulin LM, Williams D'AL, Peng R, Diette GB, McCormack MC, Breysse P, Hansel NN. 24-h Nitrogen dioxide concentration is associated with cooking behaviors and an increase in rescue medication use in children with asthma. ENVIRONMENTAL RESEARCH 2017; 159:118-123. [PMID: 28797886 PMCID: PMC5623630 DOI: 10.1016/j.envres.2017.07.052] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 07/24/2017] [Accepted: 07/31/2017] [Indexed: 05/06/2023]
Abstract
Exposure to nitrogen dioxide (NO2), a byproduct of combustion, is associated with poor asthma control in children. We sought to determine whether gas-fueled kitchen appliance use is associated with 24-h indoor NO2 concentrations and whether these concentrations are associated with asthma morbidity in children. Children aged 5-12 years old with asthma were eligible. Mean 24-h NO2 concentration was measured in the kitchen over a four-day sampling period and gas stove use was captured in time activity diaries. The relationship between stove and oven use and daily NO2 concentration was analyzed. Longitudinal analysis assessed the effect of daily NO2 exposure on symptoms, inhaler use, and lung function. Multivariate models were adjusted for age, sex, season, and maternal education. Thirty children contributed 126 participant days of sampling. Mean indoor 24-h NO2 concentration was 58(48)ppb with a median (range) of 45(12-276)ppb. All homes had gas stoves and furnaces. Each hour of kitchen appliance use was associated with an 18ppb increase in 24-h NO2 concentration. In longitudinal multivariate analysis, each ten-fold increase in previous-day NO2 was associated with increased nighttime inhaler use (OR = 4.9, p = 0.04). There were no associations between NO2 and lung function or asthma symptoms. Higher previous-day 24-h concentration of NO2 is associated with increased nighttime inhaler use in children with asthma.
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Affiliation(s)
- Laura M Paulin
- Johns Hopkins Pulmonary/Critical Care, Baltimore, MD, United States.
| | - D 'Ann L Williams
- Maryland Department of Health and Mental Hygiene, Baltimore, MD, United States
| | - Roger Peng
- Johns Hopkins Bloomberg School of Public Health, Balitmore, MD, United States
| | - Gregory B Diette
- Johns Hopkins Pulmonary/Critical Care, Baltimore, MD, United States
| | | | - Patrick Breysse
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Nadia N Hansel
- Johns Hopkins Pulmonary/Critical Care, Baltimore, MD, United States
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Abstract
Asthma is the most common chronic disease among children. It cannot be prevented but can be controlled. Industrialized countries experience high lifetime asthma prevalence that has increased over recent decades. Asthma has a complex interplay of genetic and environmental triggers. Studies have revealed complex interactions of lung structure and function genes with environmental exposures such as environmental tobacco smoke and vitamin D. Home environmental strategies can reduce asthma morbidity in children but should be tailored to specific allergens. Coupled with education and severity-specific asthma therapy, tailored interventions may be the most effective strategy to manage childhood asthma.
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Affiliation(s)
- Jessica P Hollenbach
- Department of Pediatrics, Asthma Center, The Children's Center for Community Research, CT Children's Medical Center, University of Connecticut School of Medicine, 282 Washington Street, Hartford, CT 06106, USA
| | - Michelle M Cloutier
- Department of Pediatrics, Asthma Center, The Children's Center for Community Research, Connecticut Children's Medical Center, University of Connecticut Health Center, 282 Washington Street, Hartford, CT 06106, USA.
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Tovey ER, Stelzer-Braid S, Toelle BG, Oliver BG, Reddel HK, Willenborg CM, Belessis Y, Garden FL, Jaffe A, Strachan R, Eyles D, Rawlinson WD, Marks GB. Rhinoviruses significantly affect day-to-day respiratory symptoms of children with asthma. J Allergy Clin Immunol 2015; 135:663-9.e12. [PMID: 25476729 PMCID: PMC7173323 DOI: 10.1016/j.jaci.2014.10.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 08/29/2014] [Accepted: 10/14/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND Viruses are frequently associated with acute exacerbations of asthma, but the extent to which they contribute to the level of day-to-day symptom control is less clear. OBJECTIVE We sought to explore the relationship between viral infections, host and environmental factors, and respiratory symptoms in children. METHODS Sixty-seven asthmatic children collected samples twice weekly for an average of 10 weeks. These included nasal wash fluid and exhaled breath for PCR-based detection of viral RNA, lung function measurements, and records of medication use and asthma and respiratory symptoms in the previous 3 days. Atopy, mite allergen exposure, and vitamin D levels were also measured. Mixed-model regression analyses were performed. RESULTS Human rhinoviruses (hRVs) were detected in 25.5% of 1232 nasal samples and 11.5% of breath samples. Non-hRV viruses were detected in less than 3% of samples. hRV in nasal samples was associated with asthma symptoms (cough and phlegm: odds ratio = 2.0; 95% CI = 1.4-2.86, P = .0001; wheeze and chest tightness: odds ratio = 2.34, 95% CI = 1.55-3.52, P < .0001) and with cold symptoms, as reported concurrently with sampling and 3 to 4 days later. No differences were found between the 3 hRV genotypes (hRV-A, hRV-B, and hRV-C) in symptom risk. A history of inhaled corticosteroid use, but not atopic status, mite allergen exposure, or vitamin D levels, modified the association between viruses and asthma symptoms. CONCLUSION The detection of nasal hRV was associated with a significantly increased risk of day-to-day asthma symptoms in children. Host, virus genotype, and environmental factors each had only a small or no effect on the relationship of viral infections to asthma symptoms.
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Affiliation(s)
- Euan R Tovey
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia.
| | - Sacha Stelzer-Braid
- Virology Research Laboratory, SEALS, Prince of Wales Hospital, Sydney, Australia; School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Brett G Toelle
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia; Sydney Local Health District, Sydney, Australia
| | - Brian G Oliver
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia; University of Technology Sydney, Sydney, Australia
| | - Helen K Reddel
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | | | - Yvonne Belessis
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia; Sydney Children's Hospital, Sydney, Australia
| | - Frances L Garden
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia; Ingham Institute of Applied Medical Research, New South Wales, Sydney, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Adam Jaffe
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia; Sydney Children's Hospital, Sydney, Australia
| | | | - Darryl Eyles
- Queensland Brain Institute, University of Queensland, Brisbane, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Brisbane, Australia
| | - William D Rawlinson
- Virology Research Laboratory, SEALS, Prince of Wales Hospital, Sydney, Australia; Sydney Children's Hospital, Sydney, Australia
| | - Guy B Marks
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
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15
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Kanchongkittiphon W, Mendell MJ, Gaffin JM, Wang G, Phipatanakul W. Indoor environmental exposures and exacerbation of asthma: an update to the 2000 review by the Institute of Medicine. ENVIRONMENTAL HEALTH PERSPECTIVES 2015; 123:6-20. [PMID: 25303775 PMCID: PMC4286274 DOI: 10.1289/ehp.1307922] [Citation(s) in RCA: 243] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 10/09/2014] [Indexed: 05/18/2023]
Abstract
BACKGROUND Previous research has found relationships between specific indoor environmental exposures and exacerbation of asthma. OBJECTIVES In this review we provide an updated summary of knowledge from the scientific literature on indoor exposures and exacerbation of asthma. METHODS Peer-reviewed articles published from 2000 to 2013 on indoor exposures and exacerbation of asthma were identified through PubMed, from reference lists, and from authors' files. Articles that focused on modifiable indoor exposures in relation to frequency or severity of exacerbation of asthma were selected for review. Research findings were reviewed and summarized with consideration of the strength of the evidence. RESULTS Sixty-nine eligible articles were included. Major changed conclusions include a causal relationship with exacerbation for indoor dampness or dampness-related agents (in children); associations with exacerbation for dampness or dampness-related agents (in adults), endotoxin, and environmental tobacco smoke (in preschool children); and limited or suggestive evidence for association with exacerbation for indoor culturable Penicillium or total fungi, nitrogen dioxide, rodents (nonoccupational), feather/down pillows (protective relative to synthetic bedding), and (regardless of specific sensitization) dust mite, cockroach, dog, and dampness-related agents. DISCUSSION This review, incorporating evidence reported since 2000, increases the strength of evidence linking many indoor factors to the exacerbation of asthma. Conclusions should be considered provisional until all available evidence is examined more thoroughly. CONCLUSION Multiple indoor exposures, especially dampness-related agents, merit increased attention to prevent exacerbation of asthma, possibly even in nonsensitized individuals. Additional research to establish causality and evaluate interventions is needed for these and other indoor exposures.
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16
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Gaffin JM, Kanchongkittiphon W, Phipatanakul W. Reprint of: Perinatal and early childhood environmental factors influencing allergic asthma immunopathogenesis. Int Immunopharmacol 2014; 23:337-46. [PMID: 25308874 DOI: 10.1016/j.intimp.2014.09.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 06/03/2014] [Accepted: 06/03/2014] [Indexed: 01/12/2023]
Abstract
BACKGROUND The prevalence of asthma has increased dramatically over the past several decades. While hereditary factors are highly important, the rapid rise outstrips the pace of genomic variation. Great emphasis has been placed on potential modifiable early life exposures leading to childhood asthma. METHODS We reviewed the recent medical literature for important studies discussing the role of the perinatal and early childhood exposures and the inception of childhood asthma. RESULTS AND DISCUSSION Early life exposure to allergens (house dust mite (HDM), furred pets, cockroach, rodent and mold), air pollution (nitrogen dioxide (NO2), ozone (O3), volatile organic compounds (VOCs), and particulate matter (PM)) and viral respiratory tract infections (Respiratory syncytial virus (RSV) and human rhinovirus (hRV)) has been implicated in the development of asthma in high risk children. Conversely, exposure to microbial diversity in the perinatal period may diminish the development of atopy and asthma symptoms.
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Affiliation(s)
- Jonathan M Gaffin
- Division of Respiratory Diseases, Boston Children's Hospital, Boston, MA; USA; Harvard Medical School, Boston, MA, USA.
| | - Watcharoot Kanchongkittiphon
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Wanda Phipatanakul
- Harvard Medical School, Boston, MA, USA; Division of Immunology, Boston Children's Hospital, Boston, MA, USA.
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17
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Gaffin JM, Kanchongkittiphon W, Phipatanakul W. Perinatal and early childhood environmental factors influencing allergic asthma immunopathogenesis. Int Immunopharmacol 2014; 22:21-30. [PMID: 24952205 DOI: 10.1016/j.intimp.2014.06.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 06/03/2014] [Accepted: 06/03/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND The prevalence of asthma has increased dramatically over the past several decades. While hereditary factors are highly important, the rapid rise outstrips the pace of genomic variation. Great emphasis has been placed on potential modifiable early life exposures leading to childhood asthma. METHODS We reviewed the recent medical literature for important studies discussing the role of the perinatal and early childhood exposures and the inception of childhood asthma. RESULTS AND DISCUSSION Early life exposure to allergens (house dust mite (HDM), furred pets, cockroach, rodent and mold), air pollution (nitrogen dioxide (NO(2)), ozone (O(3)), volatile organic compounds (VOCs), and particulate matter (PM)) and viral respiratory tract infections (Respiratory syncytial virus (RSV) and human rhinovirus (hRV)) has been implicated in the development of asthma in high risk children. Conversely, exposure to microbial diversity in the perinatal period may diminish the development of atopy and asthma symptoms.
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Affiliation(s)
- Jonathan M Gaffin
- Division of Respiratory Diseases, Boston Children's Hospital, Boston, MA; USA; Harvard Medical School, Boston, MA, USA.
| | - Watcharoot Kanchongkittiphon
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Wanda Phipatanakul
- Harvard Medical School, Boston, MA, USA; Division of Immunology, Boston Children's Hospital, Boston, MA, USA.
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18
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Portnoy J, Miller JD, Williams PB, Chew GL, Miller JD, Zaitoun F, Phipatanakul W, Kennedy K, Barnes C, Grimes C, Larenas-Linnemann D, Sublett J, Bernstein D, Blessing-Moore J, Khan D, Lang D, Nicklas R, Oppenheimer J, Randolph C, Schuller D, Spector S, Tilles SA, Wallace D. Environmental assessment and exposure control of dust mites: a practice parameter. Ann Allergy Asthma Immunol 2013; 111:465-507. [PMID: 24267359 PMCID: PMC5156485 DOI: 10.1016/j.anai.2013.09.018] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 09/20/2013] [Indexed: 12/15/2022]
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Abstract
BACKGROUND Adverse respiratory effects in children with asthma are associated with exposures to nitrogen dioxide (NO2). Levels indoors can be much higher than outdoors. Primary indoor sources of NO2 are gas stoves, which are used for cooking by one-third of U.S. households. We investigated the effects of indoor NO2 exposure on asthma severity among an ethnically and economically diverse sample of children, controlling for season and indoor allergen exposure. METHODS Children 5-10 years of age with active asthma (n = 1,342) were recruited through schools in urban and suburban Connecticut and Massachusetts (2006-2009) for a prospective, year-long study with seasonal measurements of NO2 and asthma severity. Exposure to NO2 was measured passively for four, month-long, periods with Palmes tubes. Asthma morbidity was concurrently measured by a severity score and frequency of wheeze, night symptoms, and use of rescue medication. We used adjusted, hierarchical ordered logistic regression models to examine associations between household NO2 exposure and health outcomes. RESULTS Every 5-fold increase in NO2 exposure above a threshold of 6 ppb was associated with a dose-dependent increase in risk of higher asthma severity score (odds ratio = 1.37 [95% confidence interval = 1.01-1.89]), wheeze (1.49 [1.09-2.03]), night symptoms (1.52 [1.16-2.00]), and rescue medication use (1.78 [1.33-2.38]). CONCLUSIONS Asthmatic children exposed to NO2 indoors, at levels well below the U.S. Environmental Protection Agency outdoor standard (53 ppb), are at risk for increased asthma morbidity. Risks are not confined to inner city children, but occur at NO2 concentrations common in urban and suburban homes.
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20
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Casas L, Tischer C, Tiesler C, Brüske I, Koletzko S, Bauer CP, Wichmann HE, von Berg A, Berdel D, Krämer U, Schaaf B, Lehmann I, Herbarth O, Heinrich J. Association of gas cooking with children's respiratory health: results from GINIplus and LISAplus birth cohort studies. INDOOR AIR 2012; 22:476-482. [PMID: 22512640 DOI: 10.1111/j.1600-0668.2012.00784.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
UNLABELLED Previous studies have found inconsistent results on the association between asthma in children and gas cooking emissions. We aimed to assess the effects of the long-term exposure to gas cooking on the onset of asthma and respiratory symptoms, focusing on wheezing, in children from two German birth cohorts: LISAplus and GINIplus. A total of 5078 children were followed until the age of 10 years. Asthma, wheezing, gas cooking, and exposure to other indoor factors were assessed through parental reported questionnaires administered periodically. Logistic and multinomial regressions adjusting for potential confounders were performed. The prevalence of asthma and persistent wheezing was higher among children exposed to gas cooking but the results were not statistically significant. Exposure to gas cooking was positively associated (P-value < 0.05) with exposure to other indoor factors (dampness, environmental tobacco smoke, and pets). Our results did not show a statistically significant association between the exposure to gas cooking and children's respiratory health. PRACTICAL IMPLICATIONS These analyses are consistent with the assumption of no effect of the exposure to low doses of nitrogen dioxide. The strong positive associations found between gas cooking and other indoor factors highlight the importance of considering other indoor factors when assessing health effects of gas cooking. Low-dose exposure to indoor nitrogen dioxide through gas cooking might not contribute to increase the risk of asthma and respiratory symptoms in children.
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Affiliation(s)
- L Casas
- Centre for Research in Environmental Epidemiology, Barcelona, Spain
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21
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Fabian MP, Stout NK, Adamkiewicz G, Geggel A, Ren C, Sandel M, Levy JI. The effects of indoor environmental exposures on pediatric asthma: a discrete event simulation model. Environ Health 2012; 11:66. [PMID: 22989068 PMCID: PMC3527278 DOI: 10.1186/1476-069x-11-66] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 09/06/2012] [Indexed: 05/19/2023]
Abstract
BACKGROUND In the United States, asthma is the most common chronic disease of childhood across all socioeconomic classes and is the most frequent cause of hospitalization among children. Asthma exacerbations have been associated with exposure to residential indoor environmental stressors such as allergens and air pollutants as well as numerous additional factors. Simulation modeling is a valuable tool that can be used to evaluate interventions for complex multifactorial diseases such as asthma but in spite of its flexibility and applicability, modeling applications in either environmental exposures or asthma have been limited to date. METHODS We designed a discrete event simulation model to study the effect of environmental factors on asthma exacerbations in school-age children living in low-income multi-family housing. Model outcomes include asthma symptoms, medication use, hospitalizations, and emergency room visits. Environmental factors were linked to percent predicted forced expiratory volume in 1 second (FEV1%), which in turn was linked to risk equations for each outcome. Exposures affecting FEV1% included indoor and outdoor sources of NO2 and PM2.5, cockroach allergen, and dampness as a proxy for mold. RESULTS Model design parameters and equations are described in detail. We evaluated the model by simulating 50,000 children over 10 years and showed that pollutant concentrations and health outcome rates are comparable to values reported in the literature. In an application example, we simulated what would happen if the kitchen and bathroom exhaust fans were improved for the entire cohort, and showed reductions in pollutant concentrations and healthcare utilization rates. CONCLUSIONS We describe the design and evaluation of a discrete event simulation model of pediatric asthma for children living in low-income multi-family housing. Our model simulates the effect of environmental factors (combustion pollutants and allergens), medication compliance, seasonality, and medical history on asthma outcomes (symptom-days, medication use, hospitalizations, and emergency room visits). The model can be used to evaluate building interventions and green building construction practices on pollutant concentrations, energy savings, and asthma healthcare utilization costs, and demonstrates the value of a simulation approach for studying complex diseases such as asthma.
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Affiliation(s)
- M Patricia Fabian
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
| | - Natasha K Stout
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Gary Adamkiewicz
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
| | - Amelia Geggel
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
| | - Cizao Ren
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
| | - Megan Sandel
- Department of General Pediatrics, Boston Medical University School of Medicine, Boston, MA, USA
| | - Jonathan I Levy
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
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Indoor environment and children's health: recent developments in chemical, biological, physical and social aspects. Int J Hyg Environ Health 2011; 215:1-18. [PMID: 21889403 DOI: 10.1016/j.ijheh.2011.07.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Revised: 07/22/2011] [Accepted: 07/25/2011] [Indexed: 12/11/2022]
Abstract
Much research is being carried out into indoor exposure to harmful agents. This review focused on the impact on children's health, taking a broad approach to the indoor environment and including chemical, microbial, physical and social aspects. Papers published from 2006 onwards were reviewed, with regards to scientific context. Most of publications dealt with chemical exposure. Apart from the ongoing issue of combustion by-products, most of these papers concerned semi volatile organic compounds (such as phthalates). These may be associated with neurotoxic, reprotoxic or respiratory effects and may, therefore, be of particular interest so far as children are concerned. In a lesser extent, volatile organic compounds (such as aldehydes) that have mainly respiratory effects are still studied. Assessing exposure to metals is still of concern, with increasing interest in bioaccessibility. Most of the papers on microbial exposure focused on respiratory tract infections, especially asthma linked to allergens and bio-aerosols. Physical exposure includes noise and electromagnetic fields, and articles dealt with the auditory and non auditory effects of noise. Articles on radiofrequency electromagnetic fields mainly concerned questions about non-thermal effects and papers on extremely low-frequency magnetic fields focused on the characterization of exposure. The impact of the indoor environment on children's health cannot be assessed merely by considering the effect of these different types of exposure: this review highlights new findings and also discusses the interactions between agents in indoor environments and also with social aspects.
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Haryanto B, Franklin P. Air pollution: a tale of two countries. REVIEWS ON ENVIRONMENTAL HEALTH 2011; 26:53-59. [PMID: 21714382 DOI: 10.1515/reveh.2011.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The fast growing economies and continued urbanization in Asian countries have increased the demand for mobility and energy in the region, resulting in high levels of air pollution in cities from mobile and stationary sources. In contrast, low level of urbanization in Australia produces low level of urban air pollution. The World Health Organization estimates that about 500,000 premature deaths per year are caused by air pollution, leaving the urban poor particularly vulnerable since they live in air pollution hotspots, have low respiratory resistance due to bad nutrition, and lack access to quality health care. Identifying the differences and similarities of air pollution levels and its impacts, between Indonesia and Australia, will provide best lesson learned to tackle air pollution problems for Pacific Basin Rim countries.
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Affiliation(s)
- Budi Haryanto
- Department of Environmental Health, Faculty of Public Health, Universitas Indonesia, Indonesia.
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24
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Abstract
The purpose of this article is to review indoor air pollution factors that can modify asthma severity, particularly in inner-city environments. While there is a large literature linking ambient air pollution and asthma morbidity, less is known about the impact of indoor air pollution on asthma. Concentrating on the indoor environments is particularly important for children, since they can spend as much as 90% of their time indoors. This review focuses on studies conducted by the Johns Hopkins Center for Childhood Asthma in the Urban Environment as well as other relevant epidemiologic studies. Analysis of exposure outcome relationships in the published literature demonstrates the importance of evaluating indoor home environmental air pollution sources as risk factors for asthma morbidity. Important indoor air pollution determinants of asthma morbidity in urban environments include particulate matter (particularly the coarse fraction), nitrogen dioxide, and airborne mouse allergen exposure. Avoidance of harmful environmental exposures is a key component of national and international guideline recommendations for management of asthma. This literature suggests that modifying the indoor environment to reduce particulate matter, NO(2), and mouse allergen may be an important asthma management strategy. More research documenting effectiveness of interventions to reduce those exposures and improve asthma outcomes is needed.
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Esplugues A, Ballester F, Estarlich M, Llop S, Fuentes V, Mantilla E, Iñiguez C. Indoor and outdoor concentrations and determinants of NO2 in a cohort of 1-year-old children in Valencia, Spain. INDOOR AIR 2010; 20:213-223. [PMID: 20408900 DOI: 10.1111/j.1600-0668.2010.00646.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
UNLABELLED Nitrogen dioxide (NO2) is produced from the exhausts of vehicles and gas appliances and is known to pose certain health risks. In this study, we characterize the exposure to this substance during the first year of life, which is an important period of development. To this end, we used passive samplers to measure indoor and outdoor NO2 levels for 2 weeks in the homes of 352 children. To compensate for the fact that NO2 levels were measured only once in each home, a correction factor was calculated to assign each child an outdoor NO2 exposure value for the first year of life. The outdoor NO2 concentrations were 26.1 microg/m(3) while those measured indoors averaged 18.0 microg/m(3). A multivariate linear regression analysis showed that the main determinants of outdoor NO2 levels were the degree of urbanization and the frequency of vehicle traffic at the location of the residence while for indoor NO2 levels the principal determinants were the type of cooking range and water heater present in the home, the season of the year, and both the country of origin and educational level of the mother. PRACTICAL IMPLICATIONS Exposure to NO2 has been related to respiratory and other health problems among children. Precise identification of the main sources of both indoor and outdoor NO2 should shed light on appropriate intervention periods and methods. Our results indicate that while population density and traffic-related variables are the main determinants of outdoor NO2 levels, the use of gas appliances have the greatest impact on indoor levels. Strategies should thus be developed to reduce such exposure, especially with regard to reducing emissions from vehicle traffic.
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Affiliation(s)
- A Esplugues
- Centro Superior de Investigaciones en Salud Pública (CSISP), Valencia, Spain.
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Gent JF, Belanger K, Triche EW, Bracken MB, Beckett WS, Leaderer BP. Association of pediatric asthma severity with exposure to common household dust allergens. ENVIRONMENTAL RESEARCH 2009; 109:768-74. [PMID: 19473655 PMCID: PMC2706291 DOI: 10.1016/j.envres.2009.04.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Revised: 04/13/2009] [Accepted: 04/20/2009] [Indexed: 05/04/2023]
Abstract
BACKGROUND Reducing exposure to household dust inhalant allergens has been proposed as one strategy to reduce asthma. OBJECTIVE To examine the dose-response relationships and health impact of five common household dust allergens on disease severity, quantified using both symptom frequency and medication use, in atopic and non-atopic asthmatic children. METHODS Asthmatic children (N=300) aged 4-12 years were followed for 1 year. Household dust samples from two indoor locations were analyzed for allergens including dust mite (Der p 1, Der f 1), cat (Fel d 1), dog (Can f 1), cockroach (Bla g 1). Daily symptoms and medication use were collected in monthly telephone interviews. Annual disease severity was examined in models including allergens, specific IgE sensitivity and adjusted for age, gender, atopy, ethnicity, and mother's education. RESULTS Der p 1 house dust mite allergen concentration of 2.0 microg/g or more from the main room and the child's bed was related to increased asthma severity independent of allergic status (respectively, OR 2.93, 95% CI 1.37, 6.30 for 2.0-10.0 microg/g and OR 2.55 95% CI 1.13, 5.73 for 10.0 microg/g). Higher pet allergen levels were associated with greater asthma severity, but only for those sensitized (cat OR 2.41 95% CI 1.19, 4.89; dog OR 2.06 95% CI 1.01, 4.22). CONCLUSION Higher levels of Der p 1 and pet allergens were associated with asthma severity, but Der p 1 remained an independent risk factor after accounting for pet allergens and regardless of Der p 1 specific IgE status.
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Affiliation(s)
- Janneane F Gent
- Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Department of Epidemiology and Public Health, Yale University School of Medicine, One Church Street, 6th Floor, New Haven, CT 06510, USA.
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Abstract
Indoor combustion produces both gases (eg, nitrogen dioxide, carbon monoxide) and particulate matter that may affect the development or exacerbation of asthma. Sources in the home include both heating devices (eg, fireplaces, woodstoves, kerosene heaters, flued [ie, vented] or nonflued gas heaters) and gas stoves for cooking. This article highlights the recent literature examining associations between exposure to indoor combustion and asthma development and severity. Since asthma is a chronic condition affecting both children and adults, both age groups are included in this article. Overall, there is some evidence of an association between exposure to indoor combustion and asthma, particularly asthma symptoms in children. Some sources of combustion such as coal stoves have been more consistently associated with these outcomes than other sources such as woodstoves.
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Affiliation(s)
- Kathleen Belanger
- Yale University School of Medicine, Department of Epidemiology and Public Health, New Haven, CT 06510, USA.
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Hansel NN, Breysse PN, McCormack MC, Matsui EC, Curtin-Brosnan J, Williams DL, Moore JL, Cuhran JL, Diette GB. A longitudinal study of indoor nitrogen dioxide levels and respiratory symptoms in inner-city children with asthma. ENVIRONMENTAL HEALTH PERSPECTIVES 2008; 116:1428-32. [PMID: 18941590 PMCID: PMC2569107 DOI: 10.1289/ehp.11349] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Accepted: 07/23/2008] [Indexed: 05/04/2023]
Abstract
BACKGROUND The effect of indoor nitrogen dioxide concentrations on asthma morbidity among inner-city preschool children is uncertain. OBJECTIVES Our goal was to estimate the effect of indoor NO2 concentrations on asthma morbidity in an inner-city population while adjusting for other indoor pollutants. METHODS We recruited 150 children (2-6 years of age) with physician-diagnosed asthma from inner-city Baltimore, Maryland. Indoor air was monitored over a 72-hr period in the children's bedrooms at baseline and 3 and 6 months. At each visit, the child's caregiver completed a questionnaire assessing asthma symptoms over the previous 2 weeks and recent health care utilization. RESULTS Children were 58% male, 91% African American, and 42% from households with annual income < $25,000; 63% had persistent asthma symptoms. The mean (+/- SD) in-home NO2 concentration was 30.0 +/- 33.7 (range, 2.9-394.0) ppb. The presence of a gas stove and the use of a space heater or oven/stove for heat were independently associated with higher NO2 concentrations. Each 20-ppb increase in NO2 exposure was associated significantly with an increase in the number of days with limited speech [incidence rate ratio (IRR) = 1.15; 95% confidence interval (CI), 1.05-1.25], cough (IRR = 1.10; 95% CI, 1.02-1.18), and nocturnal symptoms (IRR = 1.09; 95% CI, 1.02-1.16), after adjustment for potential confounders. NO2 concentrations were not associated with increased health care utilization. CONCLUSIONS Higher indoor NO2 concentrations were associated with increased asthma symptoms in preschool inner-city children. Interventions aimed at lowering NO2 concentrations in inner-city homes may reduce asthma morbidity in this vulnerable population.
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Affiliation(s)
- Nadia N. Hansel
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Patrick N. Breysse
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Meredith C. McCormack
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Elizabeth C. Matsui
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jean Curtin-Brosnan
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - D’Ann L. Williams
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer L. Moore
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer L. Cuhran
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Gregory B. Diette
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Address correspondence to G.B. Diette, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 East Monument St., Baltimore, MD 21205 USA. Telephone: (410) 502-7038. Fax: (410) 955-0036. E-mail:
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29
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Latza U, Gerdes S, Baur X. Effects of nitrogen dioxide on human health: systematic review of experimental and epidemiological studies conducted between 2002 and 2006. Int J Hyg Environ Health 2008; 212:271-87. [PMID: 18771952 DOI: 10.1016/j.ijheh.2008.06.003] [Citation(s) in RCA: 141] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 06/19/2008] [Accepted: 06/24/2008] [Indexed: 11/29/2022]
Abstract
In order to assess health effects in humans caused by environmental nitrogen dioxide (NO(2)) a systematic review of studies in humans was conducted. MEDLINE database was searched for epidemiological studies and experiments on adverse effects of NO(2) published between 2002 and 2006. The evidence with regard to NO(2) exposure limits was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) grading system and the modified three star system. Of the 214 articles retrieved 112 fulfilled the inclusion criteria. There was limited evidence that short-term exposure to a 1-h mean value below 200 microg NO(2)/m(3) is associated with adverse health effects provided by only one study on mortality in patients with severe asthma (*2+). The effect remained after adjusting for other air pollutants. There was moderate evidence that short-term exposure below a 24-h mean value of 50 microg NO(2)/m(3) at monitor stations increases hospital admissions and mortality (**2+). Evidence was also moderate when the search was restricted to susceptible populations (children, adolescents, elderly, and asthmatics). There was moderate evidence that long-term exposure to an annual mean below 40 microg NO(2)/m(3) was associated with adverse health effects (respiratory symptoms/diseases, hospital admissions, mortality, and otitis media) provided by generally consistent findings in five well-conducted cohort and case-control studies with some shortcomings in the study quality (**2+). Evidence was also moderate when the search was restricted to studies in susceptible populations (children and adolescents) and for the combination with other air pollutants. The most frequent reasons for decreased study quality were potential misclassification of exposure and selection bias. None of the high-quality observational studies evaluated was informative for the key questions due to the choice of the dose parameter (e.g., 1-week mean) and exposure levels above the limit values. Inclusion of study designs unlisted in the SIGN grading system did not bring additional evidence regarding exposures below the current air quality limit values for NO(2). As several recent studies reported adverse health effects below the current exposure limits for NO(2) particularly among susceptible populations regarding long-term exposure further research is needed. Apart from high-quality epidemiological studies on causality and the interaction of NO(2) with other air pollutants there is a need for double-blinded randomized cross-over studies among susceptible populations for further evaluation of the short-term exposure limits.
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Affiliation(s)
- Ute Latza
- Institute for Occupational Medicine and Maritime Medicine (ZfAM), University of Hamburg, Hamburg State Department for Social Affairs, Family, Health, and Consumer Protection, Hamburg, Germany.
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Recent evidence for adverse effects of residential proximity to traffic sources on asthma. Curr Opin Pulm Med 2008; 14:3-8. [PMID: 18043269 DOI: 10.1097/mcp.0b013e3282f1987a] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW A growing body of evidence indicates that residential proximity to traffic sources increases the risk for asthma and asthma exacerbations. In this review we have considered publications from 2006-2007 that examined the impact of residential traffic-related exposures on asthma occurrence and severity. RECENT FINDINGS In these studies, exposures were estimated using traffic metrics based on residential distances from major roads and freeways, traffic densities around homes, and models of traffic exposure. Overall, residential proximity to traffic sources was associated with increased asthma occurrence and exacerbations in both children and adults. Land-use regression models were superior to individual traffic metrics in explaining the variability of traffic-related pollutants. Susceptibility may also play a role in variation in the effects of traffic on asthma. SUMMARY There is consistent evidence that living near traffic sources is associated with asthma occurrence and exacerbations. Future studies have the opportunity to improve exposure estimates by measuring traffic-related pollutants near homes and schools and including time/activity patterns in prediction models. Further research is also warranted to investigate the differential impact of traffic by genetic and other susceptibility factors and to identify specific pollutants that underlie the adverse effect of traffic on asthma.
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Emberlin JC, Lewis RA. A double blind, placebo-controlled cross over trial of cellulose powder by nasal provocation with Der p1 and Der f1. Curr Med Res Opin 2007; 23:2423-31. [PMID: 17767803 DOI: 10.1185/030079907x231144] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The purpose of this study was to assess whether inert cellulose powder would reduce the response to nasal challenge with house dust mite antigens. The study aimed to investigate the efficacy of inert cellulose powder applied to the nose for the control of persistent allergic rhinitis in adults due to house dust mite allergy. The powder has been registered as a medical device since 1994 and is available in many countries as a remedy for hay fever. Anecdotal evidence reported that it reduced symptoms of persistent rhinitis but no scientific evidence exists for this. RESEARCH DESIGN AND METHODS A double blind, placebo-controlled cross over trial was conducted on 15 adult persistent rhinitis sufferers (diagnosed positive to Der p1 and/or Der f1 by SPT) and who had symptoms over the previous 2 years. The placebo was lactose powder. Challenge was by measured dose of homogenised allergenic dust. The study took place in the spring of 2006 before the main pollen seasons. MAIN OUTCOME MEASURES The primary outcome measures were observed severity scores for 3 symptom categories and the amount of ECP in nasal secretions. The secondary outcome measures were symptom scores by subject report (nasal blockage, itching of nose, throat and eyes), nasal peak inspiratory (PIFn) and expiratory flow (PEFn). RESULTS The results show significant differences for sneezing, itchy nose, runny nose and ECPs in nasal secretions. Some results are also significantly different between placebo and active for PIFn and for PEFn (all at p = 0.05). There were no adverse reactions. CONCLUSIONS The inert cellulose powder can have significant effects in reducing some symptoms of persistent rhinitis due to house dust mite allergy.
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Affiliation(s)
- J C Emberlin
- National Pollen and Aerobiology Research Unit, Institute of Health, University of Worcester, WR2 6AJ, UK.
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