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Varghese D, Ferris K, Lee B, Grigg J, Pinnock H, Cunningham S. Outdoor air pollution and near-fatal/fatal asthma attacks in children: A systematic review. Pediatr Pulmonol 2024; 59:1196-1206. [PMID: 38477643 DOI: 10.1002/ppul.26932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 01/18/2024] [Accepted: 02/12/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Globally, observational studies have demonstrated an association between high levels of air pollution and asthma attacks in children. It remains unclear whether and to what extent exposure may be associated with increased near-fatal/fatal attacks. OBJECTIVE To systematically review the evidence for an association between ambient outdoor air pollution and fatal and/or near-fatal asthma (NFA). METHODS Following Cochrane methodology, we searched MEDLINE, EMBASE, Web of Science, Scopus, and Open Grey electronic databases for studies reporting the association of fatal/NFA and air pollution (particulate matter [PM], sulfur dioxide, nitrogen dioxide, black carbon and ozone [O3]) in children. NFA was defined as requiring intensive care unit (ICU) management. RESULTS Two reviewers independently screened 1358 papers. A total of 276 studies identified asthma attacks related to air pollution, 272 did not meet inclusion criteria after full-text review. Four observational studies described fatal/NFA, of which three addressed NFA. PM2.5 (per 12.5 µg/m3 increase) and O3 (per 22 ppb increase) were associated with NFA in one study (PM2.5, relative risk: 1.26, confidence interval [CI] [1.10-1.44]), O3 (1.19 [1.01-1.40]). PM10 was associated with ICU admission in the context of thunderstorm asthma. Elemental carbon was associated equally with NFA that did not require an ICU admission (p = 0.67). Studies of fatal asthma including children did not demarcate age within the analysis. CONCLUSIONS Ozone and PM2.5 have been associated with NFA in children but synthesis is limited by the paucity of studies and methodological heterogeneity. Poor reporting of severities of asthma attacks hinders the assessment of whether outdoor air pollution is associated with an increased number of NFA/fatal attacks in children.
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Affiliation(s)
- Deepa Varghese
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Kathryn Ferris
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK
- Wellcome-Wolfson Institute For Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Bohee Lee
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Jonathan Grigg
- The Blizard Institute, Queen Mary's University, London, UK
| | - Hilary Pinnock
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Steve Cunningham
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
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Lai PS, Lam NL, Gallery B, Lee AG, Adair-Rohani H, Alexander D, Balakrishnan K, Bisaga I, Chafe ZA, Clasen T, Díaz-Artiga A, Grieshop A, Harrison K, Hartinger SM, Jack D, Kaali S, Lydston M, Mortimer KM, Nicolaou L, Obonyo E, Okello G, Olopade C, Pillarisetti A, Pinto AN, Rosenthal JP, Schluger N, Shi X, Thompson C, Thompson LM, Volckens J, Williams KN, Balmes J, Checkley W, Ozoh OB. Household Air Pollution Interventions to Improve Health in Low- and Middle-Income Countries: An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med 2024; 209:909-927. [PMID: 38619436 DOI: 10.1164/rccm.202402-0398st] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024] Open
Abstract
Background: An estimated 3 billion people, largely in low- and middle-income countries, rely on unclean fuels for cooking, heating, and lighting to meet household energy needs. The resulting exposure to household air pollution (HAP) is a leading cause of pneumonia, chronic lung disease, and other adverse health effects. In the last decade, randomized controlled trials of clean cooking interventions to reduce HAP have been conducted. We aim to provide guidance on how to interpret the findings of these trials and how they should inform policy makers and practitioners.Methods: We assembled a multidisciplinary working group of international researchers, public health practitioners, and policymakers with expertise in household air pollution from within academia, the American Thoracic Society, funders, nongovernmental organizations, and global organizations, including the World Bank and the World Health Organization. We performed a literature search, convened four sessions via web conference, and developed consensus conclusions and recommendations via the Delphi method.Results: The committee reached consensus on 14 conclusions and recommendations. Although some trials using cleaner-burning biomass stoves or cleaner-cooking fuels have reduced HAP exposure, the committee was divided (with 55% saying no and 45% saying yes) on whether the studied interventions improved measured health outcomes.Conclusions: HAP is associated with adverse health effects in observational studies. However, it remains unclear which household energy interventions reduce exposure, improve health, can be scaled, and are sustainable. Researchers should engage with policy makers and practitioners working to scale cleaner energy solutions to understand and address their information needs.
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3
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Zhang R, Li X, Li X, Zhang Q, Tang J, Liu Z, Song G, Jiang L, Yang F, Zhou J, Che H, Han Y, Qi X, Chen Y, Zhang S. Characterization of risks and pathogenesis of respiratory diseases caused by rural atmospheric PM 2.5. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 914:169878. [PMID: 38190917 DOI: 10.1016/j.scitotenv.2024.169878] [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: 10/18/2023] [Revised: 12/17/2023] [Accepted: 01/01/2024] [Indexed: 01/10/2024]
Abstract
Forty-six percent of the world's population resides in rural areas, the majority of whom belong to vulnerable groups. They mainly use cheap solid fuels for cooking and heating, which release a large amount of PM2.5 and cause adverse effects to human health. PM2.5 exhibits urban-rural differences in its health risk to the respiratory system. However, the majority of research on this issue has focused on respiratory diseases induced by atmospheric PM2.5 in urban areas, while rural areas have been ignored for a long time, especially the pathogenesis of respiratory diseases. This is not helpful for promoting environmental equity to aid vulnerable groups under PM2.5 pollution. Thus, this study focuses on rural atmospheric PM2.5 in terms of its chemical components, toxicological effects, respiratory disease types, and pathogenesis, represented by PM2.5 from rural areas in the Sichuan Basin, China (Rural SC-PM2.5). In this study, organic carbon is the most significant component of Rural SC-PM2.5. Rural SC-PM2.5 significantly induces cytotoxicity, oxidative stress, and inflammatory response. Based on multiomics, bioinformatics, and molecular biology, Rural SC-PM2.5 inhibits ribonucleotide reductase regulatory subunit M2 (RRM2) to disrupt the cell cycle, impede DNA replication, and ultimately inhibit lung cell proliferation. Furthermore, this study supplements and supports the epidemic investigation. Through an analysis of the transcriptome and human disease database, it is found that Rural SC-PM2.5 may mainly involve pulmonary hypertension, sarcoidosis, and interstitial lung diseases; in particular, congenital diseases may be ignored by epidemiological surveys in rural areas, including tracheoesophageal fistula, submucous cleft of the hard palate, and congenital hypoplasia of the lung. This study contributes to a greater scientific understanding of the health risks posed by rural PM2.5, elucidates the pathogenesis of respiratory diseases, clarifies the types of respiratory diseases, and promotes environmental equity.
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Affiliation(s)
- Ronghua Zhang
- Institute of Basic Medicine and Forensic Medicine, North Sichuan Medical College, Nanchong 637000, Sichuan, China; Department of Respiratory and Critical Care Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan, China
| | - Xiaomeng Li
- Institute of Basic Medicine and Forensic Medicine, North Sichuan Medical College, Nanchong 637000, Sichuan, China; Department of Respiratory and Critical Care Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan, China; Research Center for Atmospheric Environment, Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Sciences, Chongqing 400714, China
| | - Xuan Li
- Institute of Basic Medicine and Forensic Medicine, North Sichuan Medical College, Nanchong 637000, Sichuan, China; School of Public Health, North Sichuan Medical College, Nanchong 637000, Sichuan, China
| | - Qin Zhang
- Institute of Basic Medicine and Forensic Medicine, North Sichuan Medical College, Nanchong 637000, Sichuan, China; Department of Respiratory and Critical Care Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan, China
| | - Jiancai Tang
- Institute of Basic Medicine and Forensic Medicine, North Sichuan Medical College, Nanchong 637000, Sichuan, China; Department of Respiratory and Critical Care Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan, China
| | - Zhenzhong Liu
- School of Public Health, North Sichuan Medical College, Nanchong 637000, Sichuan, China
| | - Guiqin Song
- Institute of Basic Medicine and Forensic Medicine, North Sichuan Medical College, Nanchong 637000, Sichuan, China
| | - Li Jiang
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan, China
| | - Fumo Yang
- College of Architecture and Environment, Sichuan University, Chengdu 610065, China
| | - Jiawei Zhou
- Research Center for Atmospheric Environment, Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Sciences, Chongqing 400714, China
| | - Hanxiong Che
- Research Center for Atmospheric Environment, Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Sciences, Chongqing 400714, China
| | - Yan Han
- Research Center for Atmospheric Environment, Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Sciences, Chongqing 400714, China
| | - Xin Qi
- Research Center for Atmospheric Environment, Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Sciences, Chongqing 400714, China
| | - Yang Chen
- Research Center for Atmospheric Environment, Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Sciences, Chongqing 400714, China.
| | - Shumin Zhang
- Institute of Basic Medicine and Forensic Medicine, North Sichuan Medical College, Nanchong 637000, Sichuan, China; Department of Respiratory and Critical Care Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan, China.
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Hannah E, Etter-Phoya R, Lopez M, Hall S, O’Hare B. Impact of higher-income countries on child health in lower-income countries from a climate change perspective. A case study of the UK and Malawi. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002721. [PMID: 38175830 PMCID: PMC10766172 DOI: 10.1371/journal.pgph.0002721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/21/2023] [Indexed: 01/06/2024]
Abstract
Climate change is the number one threat to child health according to the World Health Organisation. It increases existing inequalities, and lower-income countries are disproportionately affected. This is unjust. Higher-income countries have contributed and continue to contribute more to climate change than lower-income countries. This has been recognised by the United Nations Committee on the Rights of the Child, which has ruled that states can be held responsible if their carbon emissions harm child rights both within and outside their jurisdiction. Nevertheless, there are few analyses of the bilateral relationship between higher- and lower-income countries concerning climate change. This article uses the UK and Malawi as a case study to illustrate higher-income countries' impact on child health in lower-income countries. It aims to assist higher-income countries in developing more targeted policies. Children in Malawi can expect more food insecurity and reduced access to clean water, sanitation, and education. They will be more exposed to heat stress, droughts, floods, air pollution and life-threatening diseases, such as malaria. In 2019, 5,000 Malawian children died from air pollution (17% of under-five deaths). The UK needs to pay its 'fair share' of climate finance and ensure adaptation is prioritised for lower-income countries. It can advocate for more equitable and transparent allocation of climate finance to support the most vulnerable countries. Additionally, the UK can act domestically to curtail revenue losses in Malawi and other lower-income countries, which would free up resources for adaptation. In terms of mitigation, the UK must increase its nationally determined commitments by 58% to reach net zero and include overseas emissions. Land use, heating systems and renewable energy must be reviewed. It must mandate comprehensive scope three emission reporting for companies to include impacts along their value chain, and support businesses, multinational corporations, and banks to reach net zero.
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Affiliation(s)
- Eilish Hannah
- School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | - Rachel Etter-Phoya
- School of Medicine, University of St Andrews, St Andrews, United Kingdom
- Tax Justice Network, Lilongwe, Malawi
| | - Marisol Lopez
- School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | - Stephen Hall
- School of Economics, University of Leicester, Leicester, United Kingdom
- University of Pretoria, Pretoria, South Africa
| | - Bernadette O’Hare
- School of Medicine, University of St Andrews, St Andrews, United Kingdom
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5
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Mphahlele R, Lesosky M, Masekela R. Prevalence, severity and risk factors for asthma in school-going adolescents in KwaZulu Natal, South Africa. BMJ Open Respir Res 2023; 10:10/1/e001498. [PMID: 37192778 DOI: 10.1136/bmjresp-2022-001498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 05/02/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Asthma remains highly prevalent, with more severe symptoms in low-income to middle-income countries (LMICs) compared with high-income countries. Identifying risk factors for severe asthma symptoms can assist with improving outcomes. We aimed to determine the prevalence, severity and risk factors for asthma in adolescents in an LMIC. METHODS A cross-sectional survey using the Global Asthma Network written and video questionnaires was conducted in adolescents aged 13 and 14 from randomly selected schools in Durban, South Africa, between May 2019 and June 2021. RESULTS A total of 3957 adolescents (51.9% female) were included. The prevalence of lifetime, current and severe asthma was 24.6%, 13.7% and 9.1%, respectively. Of those with current and severe asthma symptoms; 38.9% (n=211/543) and 40.7% (n=147/361) had doctor-diagnosed asthma; of these, 72.0% (n=152/211) and 70.7% (n=104/147), respectively, reported using inhaled medication in the last 12 months. Short-acting beta agonists (80.4%) were more commonly used than inhaled corticosteroids (13.7%). Severe asthma was associated with: fee-paying school quintile (adjusted OR (CI)): 1.78 (1.27 to 2.48), overweight (1.60 (1.15 to 2.22)), exposure to traffic pollution (1.42 (1.11 to 1.82)), tobacco smoking (2.06 (1.15 to 3.68)), rhinoconjunctivitis (3.62 (2.80 to 4.67)) and eczema (2.24 (1.59 to 3.14)), all p<0.01. CONCLUSION Asthma prevalence in this population (13.7%) is higher than the global average (10.4%). Although common, severe asthma symptoms are underdiagnosed and associated with atopy, environmental and lifestyle factors. Equitable access to affordable essential controller inhaled medicines addressing the disproportionate burden of asthma is needed in this setting.
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Affiliation(s)
- Reratilwe Mphahlele
- Paediatrics and Child Health, University of KwaZulu Natal, Durban, KwaZulu Natal, South Africa
| | - Maia Lesosky
- Division of Epidemiology and Biostatistics, University of Cape Town, Rondebosch, South Africa
- Global Health Trials Unit, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Refiloe Masekela
- Paediatrics and Child Health, University of KwaZulu Natal, Durban, KwaZulu Natal, South Africa
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6
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Nkereuwem E, Agbla S, Sallahdeen A, Owolabi O, Sillah AK, Genekah M, Tunkara A, Kandeh S, Jawara M, Saidy L, Bush A, Togun T, Kampmann B. Reduced lung function and health-related quality of life after treatment for pulmonary tuberculosis in Gambian children: a cross-sectional comparative study. Thorax 2023; 78:281-287. [PMID: 36109164 PMCID: PMC9985734 DOI: 10.1136/thorax-2022-219085] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/25/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Post-tuberculosis (post-TB) lung disease is an under-recognised consequence of pulmonary tuberculosis (pTB). We aimed to estimate the prevalence of residual lung function impairment and reduced health-related quality of life (HRQoL) in children after pTB treatment completion. METHODS We conducted a cross-sectional comparative study of children aged less than 15 years at TB diagnosis who had completed treatment for pTB at least 6 months previously with a comparator group of age-matched children without a history of pTB. Symptoms, spirometry and HRQoL measured with PedsQL scale were collected. Variables associated with lung function impairment were identified through logistic regression models. RESULTS We enrolled 68 post-TB cases (median age 8.9 (IQR 7.2-11.2) years) and 91 children in the comparison group (11.5 (8.0-13.7) years). Spirometry from 52 (76.5%) post-TB cases and 89 (94.5%) of the comparison group met the quality criteria for acceptability and repeatability. Lung function impairment was present in 20/52 (38.5%) post-TB cases and 15/86 (17.4%) in the comparison group, p=0.009. Previous pTB and a history of chronic cough were significantly associated with the presence of lung function impairment (p=0.047 and 0.006 respectively). Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC z-scores were significantly lower in the post-TB cases compared with the comparison group (p= <0.001, 0.014 and <0.001, respectively). The distribution of the self-reported physical health score, and parent-reported physical, emotional, psychological, social and total HRQoL scores were significantly lower in the post-TB cases compared with the comparison group. CONCLUSIONS Previous TB in children is associated with significantly impaired lung function and HRQoL.
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Affiliation(s)
- Esin Nkereuwem
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, Gambia .,Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Schadrac Agbla
- Department of Health Data Science, University of Liverpool, Liverpool, UK.,Department of Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Azeezat Sallahdeen
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Olumuyiwa Owolabi
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Abdou K Sillah
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Monica Genekah
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Abdoulie Tunkara
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Sheriff Kandeh
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Maryama Jawara
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Lamin Saidy
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Andrew Bush
- Department of Paediatric Respiratory Medicine, National Heart & Lung Institute, Imperial College London - Royal Brompton Campus, London, UK.,Centre for Paediatrics and Child Health, Imperial College London, London, UK
| | - Toyin Togun
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, Gambia.,Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.,TB Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Beate Kampmann
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, Gambia.,Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.,Vaccine Centre, London School of Hygiene & Tropical Medicine, London, UK
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7
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Anake WU, Nnamani EA. Indoor air quality in day-care centres: a global review. AIR QUALITY, ATMOSPHERE, & HEALTH 2023; 16:997-1022. [PMID: 36819788 PMCID: PMC9930043 DOI: 10.1007/s11869-023-01320-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 01/31/2023] [Indexed: 05/23/2023]
Abstract
A healthy indoor environment is critical for children due to the severe effect of poor indoor air quality (IAQ) on their overall well-being. Day-care centres (DCCs) are important indoor microenvironments for children apart from their homes. Therefore, monitoring IAQ in this microenvironment is vital because of the vulnerability of the occupants. This review gives a global overview of the predominant indoor chemical pollutant levels monitored in DCCs, compares their concentration with available regulations for IAQ, evaluates the sources and health risk effects of chemical pollutants and proposes strategies for enhancing IAQ in DCCs. Thirty-seven (37) articles were used based on specific stated inclusion and exclusion criteria. Continents like Europe and Asia have the most published studies in indoor DCCs. The decreasing trend of pollutants examined in most studies include particulate matter > carbon dioxide > formaldehyde > carbon monoxide > total volatile organic compounds > volatile organic compounds > nitrogen dioxide > ozone > benzene > sulphur dioxide = radon. Particulate matter in the size and mass concentration range of PM10 (0.116-1920.71 μg/m3) > PM2.5 (0.279.2-260.74 μg/m3) was the most investigated pollutant. While nitrogen dioxide, radon and carbon monoxide were consistent with the existing national and international reference values for IAQ across the continents, exceedances occurred in other pollutants. The limited number of indoor chemical pollutant studies suggests the need for more comprehensive studies on IAQ in DCC globally. Further studies should highlight the availability of low-cost sensors and mobile analytical equipment that will promote affordable ground-level data accessibility. Supplementary Information The online version contains supplementary material available at 10.1007/s11869-023-01320-5.
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Affiliation(s)
- Winifred U. Anake
- Department of Chemistry, College of Science & Technology, Covenant University, Km10 Idiroko Road, Ota, Nigeria
| | - Esther A. Nnamani
- Department of Chemistry, College of Science & Technology, Covenant University, Km10 Idiroko Road, Ota, Nigeria
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8
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Chung KF, McGarvey L, Song WJ, Chang AB, Lai K, Canning BJ, Birring SS, Smith JA, Mazzone SB. Cough hypersensitivity and chronic cough. Nat Rev Dis Primers 2022; 8:45. [PMID: 35773287 PMCID: PMC9244241 DOI: 10.1038/s41572-022-00370-w] [Citation(s) in RCA: 94] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 12/13/2022]
Abstract
Chronic cough is globally prevalent across all age groups. This disorder is challenging to treat because many pulmonary and extrapulmonary conditions can present with chronic cough, and cough can also be present without any identifiable underlying cause or be refractory to therapies that improve associated conditions. Most patients with chronic cough have cough hypersensitivity, which is characterized by increased neural responsivity to a range of stimuli that affect the airways and lungs, and other tissues innervated by common nerve supplies. Cough hypersensitivity presents as excessive coughing often in response to relatively innocuous stimuli, causing significant psychophysical morbidity and affecting patients' quality of life. Understanding of the mechanisms that contribute to cough hypersensitivity and excessive coughing in different patient populations and across the lifespan is advancing and has contributed to the development of new therapies for chronic cough in adults. Owing to differences in the pathology, the organs involved and individual patient factors, treatment of chronic cough is progressing towards a personalized approach, and, in the future, novel ways to endotype patients with cough may prove valuable in management.
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Affiliation(s)
- Kian Fan Chung
- Experimental Studies Unit, National Heart & Lung Institute, Imperial College London, London, UK
- Department of Respiratory Medicine, Royal Brompton and Harefield Hospital, London, UK
| | - Lorcan McGarvey
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Anne B Chang
- Australian Centre for Health Services Innovation, Queensland's University of Technology and Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Division of Child Health, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Kefang Lai
- The First Affiliated Hospital of Guangzhou Medical University, National Center of Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | | | - Surinder S Birring
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Jaclyn A Smith
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Stuart B Mazzone
- Department of Anatomy and Physiology, University of Melbourne, Victoria, Australia.
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9
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Naidu ST, Ferreira RM, Oliveira TDQ, Gondim FDL, Serra DS, Cavalcante FSÁ. Respiratory effects caused by exposure to diesel exhaust particles during moderate exercise: a murine model. J Appl Physiol (1985) 2022; 132:1536-1545. [PMID: 35446598 DOI: 10.1152/japplphysiol.00115.2021] [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: 11/22/2022] Open
Abstract
Aerobic exercise is an increasing trend worldwide. However, people are increasingly exercising outdoors, alongside roadways where heavy vehicles release diesel exhaust. We analyzed respiratory effects caused by inhaled diesel particulate emitted by vehicles adhering to Brazilian legislation, PROCONVE Phase P7 (equivalent to EURO 5), as well the effects of exposure during moderate-intensity aerobic exercise. Male C57BL/6 mice were divided into four groups for a 4-wk treadmill protocol: CE (n = 8) received intranasal sterile physiological saline and then performed moderate-intensity exercise (control), CS (n = 10) received saline and then remained stationary on the treadmill (control), DS (n = 9) received intranasal diesel exhaust particles and then remained stationary, and DE (n = 10) was exposed to diesel exhaust and then exercised at moderate intensity. Mice were subsequently connected to a mechanical ventilator (SCIREQ flexiVent, Canada) to analyze the following respiratory mechanics parameters: tissue resistance, elastance, inspiratory capacity, static compliance, Newtonian resistance, and pressure-volume loop area. After euthanasia, peripheral pulmonary tissue strips were extracted and subjected to force-length tests to evaluate parenchymal elastic and mechanical properties, using oscillations applied by a computer-controlled force transducer system; parameters obtained were tissue resistance, elastance, and hysteresivity. DS displayed impaired respiratory mechanics for all parameters, in comparison with CS. DE exhibited significantly reduced inspiratory capacity and static compliance, and increased Newtonian resistance when compared with CE. Exposure to diesel exhaust, both during exercise and rest, still exerts harmful pulmonary effects, even at current legislation limits. These results justify further changes in environmental standards, to reduce the health risks caused by traffic-related pollution.NEW & NOTEWORTHY Exercise, while beneficial, is often performed in areas of greater inhaled particulates. Here we show this effect using mice exposed to controlled diesel particle inhalation and moderate aerobic exercise. Diesel particle inhalation, without or with exercise, worsened both respiratory mechanical properties associated with changes in lung tissue mechanics and morphometry.
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10
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Eze JN, Ozoh OB, Otuu FC, Shu EN, Anyaehie BU. Respiratory symptoms and lung function among inmates in a Nigerian prison: a cross sectional study. BMC Pulm Med 2022; 22:84. [PMID: 35287649 PMCID: PMC8918425 DOI: 10.1186/s12890-022-01882-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background Prisoners in low- and middle-income countries are vulnerable to poor lung health from multiple adverse conditions confronted within the prison such as overcrowding, poor ventilation and exposure to second hand smoke. Evidence for poor lung health in this disadvantaged group is needed to inform policy on prison conditions in this region. We assessed the respiratory symptoms and lung function measured by spirometry among prisoners in Enugu, Nigeria and explored the associations between them.
Methods This was a cross‑sectional study among prison inmates aged 16–76 years. We assessed frequency of respiratory symptoms in the preceding one-year, previous respiratory diagnosis, tobacco smoking status and spirometry. The relationships between respiratory symptoms, smoking status and spirometry pattern were determined using the Chi‑square test. Results Of 245 participants, 170 (69.4%) reported at least one respiratory symptom. In all, 214 (87.3%) performed spirometry and 173 (80.8%) had good quality spirometry tests. Using the Global Lung Function Initiative (GLI) predicted values for ‘African Americans’, spirometry results were abnormal in 41 (23.7%) of the participants and when the GLI reference values for ‘Other’ ethnic groups was applied, 78 (45.1%) had abnormal results. Restrictive impairment was most common occurring in 21 (12.1%) and 59 (34.1%) respectively based on the two reference values, and obstructive pattern was found in 18 (10.4%) and 13 (7.5%) respectively. There was no significant association between abnormal spirometry pattern and presence of respiratory symptoms or smoking status. No previous diagnosis for asthma, or bronchitis/chronic obstructive pulmonary disease (COPD) had been made in any of the participants. Conclusions We reported high rates of respiratory symptoms and abnormal lung function with under-diagnosis of chronic respiratory diseases among inmates in Enugu prison. The restrictive abnormalities based on GLI equations remain unexplained. There is need for improvement in prison facilities that promote lung health and enhanced access to diagnosis and treatment of respiratory non-communicable disease. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01882-7.
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Affiliation(s)
- Joy Nkiru Eze
- Department of Paediatrics, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, 400001, Nigeria.
| | - Obianuju Beatrice Ozoh
- Department of Medicine, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | | | - Elvis Neba Shu
- Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Bond Ugochukwu Anyaehie
- Department of Human Physiology, Faculty of Basic Medical Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
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11
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Mortimer K, Montes de Oca M, Salvi S, Balakrishnan K, Hadfield RM, Ramirez-Venegas A, Halpin DMG, Ozoh Obianuju B, Han MeiLan K, Perez Padilla R, Kirenga B, Balmes JR. Household air pollution and COPD: cause and effect or confounding by other aspects of poverty? Int J Tuberc Lung Dis 2022; 26:206-216. [PMID: 35197160 PMCID: PMC8886958 DOI: 10.5588/ijtld.21.0570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
SETTING : Household air pollution (HAP) and chronic obstructive pulmonary disease (COPD) are both major public health problems, reported to cause around 4 million and 3 million deaths every year, respectively. The great majority of these deaths, as well as the burden of disease during life is felt by people in low- and middle-income countries (LMICs). OBJECTIVE AND DESIGN : The extent to which HAP causes COPD is controversial; we therefore undertook this review to offer a viewpoint on this from the Global Initiative for COPD (GOLD). RESULTS : We find that while COPD is well-defined in many studies on COPD and HAP, there are major limitations to the definition and measurement of HAP. It is thus difficult to disentangle HAP from other features of poverty that are themselves associated with COPD. We identify other limitations to primary research studies, including the use of cross-sectional designs that limit causal inference. CONCLUSION : There is substantial preventable morbidity and mortality associated with HAP, COPD and poverty, separately and together. Although it may not be possible to define clear causal links between HAP and COPD, there is a clear urgency to reduce the avoidable burden of disease these inflict on the world’s poor.
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Affiliation(s)
- K Mortimer
- University of Cambridge, Cambridge, UK, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - M Montes de Oca
- Hospital Universitario de Caracas Universidad Central de Venezuela and Centro Médico de Caracas, Caracas, Venezuela
| | - S Salvi
- Pulmocare Research and Education (PURE) Foundation, Pune, India
| | | | - R M Hadfield
- Australian Institute for Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - A Ramirez-Venegas
- Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias, Mexico
| | - D M G Halpin
- College of Medicine and Health, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - B Ozoh Obianuju
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | - R Perez Padilla
- Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias, Mexico
| | - B Kirenga
- Makerere University Lung Institute, Kampala, Uganda
| | - J R Balmes
- Department of Medicine, University of California, San Francisco and Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
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12
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Zeng LH, Hussain M, Syed SK, Saadullah M, Jamil Q, Alqahtani AM, Alqahtani T, Akram N, Khan IA, Parveen S, Fayyaz T, Fatima M, Shaukat S, Shabbir N, Fatima M, Kanwal A, Barkat MQ, Wu X. Revamping of Chronic Respiratory Diseases in Low- and Middle-Income Countries. Front Public Health 2022; 9:757089. [PMID: 35265582 PMCID: PMC8899038 DOI: 10.3389/fpubh.2021.757089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/29/2021] [Indexed: 01/09/2023] Open
Abstract
Low- and middle-income countries (LMICs) endure an asymmetrically high burden of worldwide disease and death caused by chronic respiratory diseases (CRDs), i.e., asthma, emphysema, bronchiectasis, and post-tuberculosis lung disease (PTLD). CRDs are firmly related with indigence, infectious diseases, and other non-communicable diseases (NCDs) and add to complex multi-disease with great impact on the lives and livelihood of those affected. The pertinence of CRDs to health and demographic wellbeing is relied upon to increment in the long time ahead, as expectations of life rise and the contending dangers of right on time youth mortality and irresistible infections level. The WHO has distinguished the counteraction and control of NCDs as an earnest improvement issue and crucial for the sustainable development goals (SDSs) by 2030. In this review, we center on CRDs in LMICs. We examine the early life roots of CRDs, challenges in their avoidance, identification and administration in LMICs, and the pathways to resolve for accomplish valid widespread wellbeing inclusion.
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Affiliation(s)
- Ling-Hui Zeng
- Department of Pharmacology, Zhejiang University City College, Hangzhou, China
| | - Musaddique Hussain
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Shahzada Khurram Syed
- Department of Basic Medical Sciences, School of Health Sciences, University of Management and Technology Lahore, Lahore, Pakistan
| | - Malik Saadullah
- Department of Pharmaceutical Chemistry, Government College University, Faisalabad, Pakistan
| | - Qurratulain Jamil
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Ali M. Alqahtani
- Department of Pharmacology, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Taha Alqahtani
- Department of Pharmacology, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Nadia Akram
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Imran Ahmad Khan
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Sajida Parveen
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Tehreem Fayyaz
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Mobeen Fatima
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Saira Shaukat
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Najia Shabbir
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Mehwish Fatima
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Aisha Kanwal
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | | | - Ximei Wu
- Department of Pharmacology, Zhejiang University City College, Hangzhou, China
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13
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Dida GO, Lutta PO, Abuom PO, Mestrovic T, Anyona DN. Factors predisposing women and children to indoor air pollution in rural villages, Western Kenya. Arch Public Health 2022; 80:46. [PMID: 35093174 PMCID: PMC8801101 DOI: 10.1186/s13690-022-00791-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 01/07/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Indoor air pollution (IAP) remains a major global public health hazard more so in developing countries where use of fossil fuels is still very common. However, despite the popularity of kerosene and fuelwood as energy sources among many households in the Sub-Saharan Africa, little is known about their health effects and the predisposing factors particularly on those with direct exposure. This study sought to relate indoor air pollution exposure to self-reported prevalence of respiratory outcomes including (sputum production, congestion, breathing difficulties, eye problems, fatigue, and headaches and wheezing) among women and children of Trans Nzoia County, in the rural villages of western Kenya. METHODS In this cross-sectional survey, simple random technique was used to select 251 households from 14 villages. Households were the sampling units, while the woman of the household with/or in custody of a child aged less than 5 years old were the unit of analysis. A total of 251 women with/or in custody of a child aged less than 5 years old took part in the study. A structured questionnaire was used to collect information on cause and effects of IAP among women and children. Data was analyzed descriptively and inferentially. We used Poisson generalized linear models with IAP symptoms and indoor cooking as dependent variables and household profiles and other socio-demographics as independent variables to identify the factors that affect health outcome. RESULTS Mean age of respondents was 36.49 years, (95% CI [35.5, 37.5]). Most (64.5%) houses were semi-permanent, with 58.6% having an average kitchen size (5.6 m2). Wood and kerosene were the most preferred fuel types for cooking (96.8%) and lighting (97.4%), respectively. Smoke from the wood was identified as the dominant (96.8%) source of IAP. Most women (92.0%) and children (95.4%) had coughs of varying intensities during the year, while 31.5% of the women reported wheezing. About 98% of them experienced fatigued and headaches. Use of wood fuel was associated with increased coughing (p = 0.03), phlegm (p = 0.02), wheezing (p = 0.04), eye problems (p = 0.03) and headaches (p = 0.01) among women and children in the previous 24 h. Education level, ventilation, main fuel source used in 24 h, indoor cooking and house type were significantly associated with IAP health effects (p ≤ 0.05). CONCLUSIONS Supporting the impoverished households and increasing their level of awareness on health-effects of IAP occasioned by use of biomass fuel while cooking indoors may be the first step in implementing a programme aimed at reducing exposure among rural households in Trans Nzoia County, in rural parts of Western Kenya.
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Affiliation(s)
- Gabriel O Dida
- Department of Health Systems Management and Public Health, Technical University of Kenya, Nairobi, Kenya.
- School of Public Health and Community Development, Maseno University, Kisumu, Kenya.
| | - Patrick O Lutta
- School of Public Health and Community Development, Maseno University, Kisumu, Kenya
| | - Paul O Abuom
- Deparment of Environmental Science, Maseno University, Kisumu, Kenya
| | - Tomislav Mestrovic
- University Centre Varazdin, University North, Varazdin, Croatia
- Institute for Health Metrics and Evaluation and the Department of Health Metrics Sciences, University of Washington, Seattle, USA
| | - Douglas N Anyona
- Deparment of Environmental Science, Maseno University, Kisumu, Kenya
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14
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Wang X, Guo Y, Cai M, Qian ZM, Zhang S, Zhang Z, Yang Y, Vaughn MG, Aaron HE, Wu F, Zhang Y, Lin H. Constituents of fine particulate matter and asthma in six low- and middle-income countries. J Allergy Clin Immunol 2021; 150:214-222.e5. [PMID: 34971647 DOI: 10.1016/j.jaci.2021.12.779] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/19/2021] [Accepted: 12/09/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Evidence concerning the effects of different chemical components of PM2.5 on asthma is limited, and the methodology to compare the relative importance of different PM2.5 components is lacking. OBJECTIVES To examine the associations between PM2.5 components and asthma, and investigate which constituent of PM2.5 possessed the most harmful effect on asthma. METHODS A total of 45,690 subjects were surveyed in six countries from 2007 to 2010. We geo-coded the residential community address of the participants, and used satellite remote sensing and chemical transport modeling to estimate their annual average concentrations. Mixed-effects generalized additive models were utilized to examine the associations between PM2.5 constituents and prevalence of asthma. We further used counterfactual analyses to determine the potential number of asthma cases. RESULTS We identified 6,178 asthma cases among the participants, producing a prevalence of 13.5%. The odds ratio (OR) for asthma associated with per standard deviation (SD) increment was 1.12 for PM2.5 mass, 1.12 for organic carbon (OC), 1.18 for black carbon (BC), 1.19 for sulfate, 1.28 for ammonium, and 1.21 for nitrate after controlling for potential confounders. Our counterfactual analyses suggested that ammonium was responsible for a substantial decline in asthma cases (1382, corresponding to 22.37% of overall cases) if the concentration was reduced to the 5th percentile of the current level. CONCLUSIONS Our study suggests that some chemical components (including BC, OC, sulfate, ammonium, and nitrate) of PM2.5 might be hazardous constituents contributing to the prevalence of asthma, among them, ammonium might be responsible for substantial proportion of asthma cases if reduced to a certain level.
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Affiliation(s)
- Xiaojie Wang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yanfei Guo
- Shanghai Municipal Centre for Disease Control and Prevention (Shanghai CDC), Shanghai, China
| | - Miao Cai
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zhengmin Min Qian
- Department of Epidemiology and Biostatistics, College for Public Health & Social Justice, Saint Louis University, USA
| | - Shiyu Zhang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zilong Zhang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yin Yang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Michael G Vaughn
- School of Social Work, College for Public Health & Social Justice, Saint Louis University, USA
| | - Hannah E Aaron
- Department of Epidemiology and Biostatistics, College for Public Health & Social Justice, Saint Louis University, USA
| | - Fan Wu
- School of Public Health, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Yuqiang Zhang
- Nicholas School of the Environment, Duke University, Durham, NC, USA.
| | - Hualiang Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.
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15
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Saleh S, Sambakunsi H, Mortimer K, Morton B, Kumwenda M, Rylance J, Chinouya M. Exploring smoke: an ethnographic study of air pollution in rural Malawi. BMJ Glob Health 2021; 6:bmjgh-2021-004970. [PMID: 34193474 PMCID: PMC8246283 DOI: 10.1136/bmjgh-2021-004970] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/13/2021] [Indexed: 12/13/2022] Open
Abstract
Air pollution adversely affects human health, and the climate crisis intensifies the global imperative for action. Low-/middle-income countries (LMIC) suffer particularly high attributable disease burdens. In rural low-resource settings, these are linked to cooking using biomass. Proposed biomedical solutions to air pollution typically involve ‘improved cooking technologies’, often introduced by high-income country research teams. This ethnography, set in a rural Malawian village, aimed to understand air pollution within its social and environmental context. The results provide a multifaceted account through immersive participant observations with concurrent air quality monitoring, interviews and participatory workshops. Data included quantitative measures of individuals’ air pollution exposures paired with activity, qualitative insights into how smoke is experienced in daily life throughout the village, and participants’ reflections on potential cleaner air solutions. Individual air quality monitoring demonstrated that particulate levels frequently exceeded upper limits recommended by the WHO, even in the absence of identified sources of biomass burning. Ethnographic findings revealed the overwhelming impact of economic scarcity on individual air pollution exposures. Scarcity affected air pollution exposures through three pathways: daily hardship, limitation and precarity. We use the theory of structural violence, as described by Paul Farmer, and the concept of slow violence to interrogate the origins of this scarcity and global inequality. We draw on the ethnographic findings to critically consider sustainable approaches to cleaner air, without re-enacting existing systemic inequities.
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Affiliation(s)
- Sepeedeh Saleh
- Liverpool School of Tropical Medicine, Liverpool, UK .,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Henry Sambakunsi
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | | | - Ben Morton
- Liverpool School of Tropical Medicine, Liverpool, UK.,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Moses Kumwenda
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Jamie Rylance
- Liverpool School of Tropical Medicine, Liverpool, UK
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16
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Ramírez-Venegas A, Montiel-Lopez F, Falfan-Valencia R, Pérez-Rubio G, Sansores RH. The "Slow Horse Racing Effect" on Lung Function in Adult Life in Chronic Obstructive Pulmonary Disease Associated to Biomass Exposure. Front Med (Lausanne) 2021; 8:700836. [PMID: 34307427 PMCID: PMC8295605 DOI: 10.3389/fmed.2021.700836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/15/2021] [Indexed: 01/31/2023] Open
Abstract
Although different trajectories in lung function decline have been identified in patients with COPD associated to tobacco exposure (TE-COPD), genetic, environmental, and infectious factors affecting lung function throughout life have not been fully elucidated in patients with COPD associated to biomass (BE-COPD). In this review, we present current epidemiological findings and notable advances in the natural history of lung decline in BE-COPD, as well as conditions modeling the FEV1 trajectory, such as health insults, during the first years of childhood. Evidence shows that women exposed to biomass smoke reach adult life with a lower FEV1 than expected. However, in contrast to the “horse racing effect” predicting an excessive lung-function decline in forthcoming years, as observed in smokers, this decline is slower in non-smokers, and no rapid decliners are observed. Accordingly, BE-COPD might be considered another phenotype of COPD based on assessments of lung function decline. Likewise, other functional and clinical aspects described in this review suggest that this condition might be similar to TE-COPD. More research is needed to fully characterize this subgroup of variants of COPD.
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Affiliation(s)
- Alejandra Ramírez-Venegas
- Department of Tobacco Smoking and COPD Research, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Francisco Montiel-Lopez
- Department of Tobacco Smoking and COPD Research, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Ramces Falfan-Valencia
- HLA Laboratory, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Gloria Pérez-Rubio
- HLA Laboratory, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Raúl H Sansores
- Department of Respiratory Medicine, Medica Sur Clinic and Foundation, Mexico City, Mexico
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17
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Meghji J, Mortimer K, Agusti A, Allwood BW, Asher I, Bateman ED, Bissell K, Bolton CE, Bush A, Celli B, Chiang CY, Cruz AA, Dinh-Xuan AT, El Sony A, Fong KM, Fujiwara PI, Gaga M, Garcia-Marcos L, Halpin DMG, Hurst JR, Jayasooriya S, Kumar A, Lopez-Varela MV, Masekela R, Mbatchou Ngahane BH, Montes de Oca M, Pearce N, Reddel HK, Salvi S, Singh SJ, Varghese C, Vogelmeier CF, Walker P, Zar HJ, Marks GB. Improving lung health in low-income and middle-income countries: from challenges to solutions. Lancet 2021; 397:928-940. [PMID: 33631128 DOI: 10.1016/s0140-6736(21)00458-x] [Citation(s) in RCA: 132] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/22/2020] [Accepted: 09/28/2020] [Indexed: 01/19/2023]
Abstract
Low-income and middle-income countries (LMICs) bear a disproportionately high burden of the global morbidity and mortality caused by chronic respiratory diseases (CRDs), including asthma, chronic obstructive pulmonary disease, bronchiectasis, and post-tuberculosis lung disease. CRDs are strongly associated with poverty, infectious diseases, and other non-communicable diseases (NCDs), and contribute to complex multi-morbidity, with major consequences for the lives and livelihoods of those affected. The relevance of CRDs to health and socioeconomic wellbeing is expected to increase in the decades ahead, as life expectancies rise and the competing risks of early childhood mortality and infectious diseases plateau. As such, the World Health Organization has identified the prevention and control of NCDs as an urgent development issue and essential to the achievement of the Sustainable Development Goals by 2030. In this Review, we focus on CRDs in LMICs. We discuss the early life origins of CRDs; challenges in their prevention, diagnosis, and management in LMICs; and pathways to solutions to achieve true universal health coverage.
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Affiliation(s)
- Jamilah Meghji
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kevin Mortimer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Global Initiative for Asthma (GINA), Fontana, WI, USA; Global Initiative for COPD (GOLD), Fontana, WI, USA; British Thoracic Society Global Health Group, London, UK; Global Asthma Network (GAN), Auckland, New Zealand; Pan African Thoracic Society, Durban, South Africa; International Union Against Tuberculosis and Lung Diseases, Paris, France.
| | - Alvar Agusti
- Global Initiative for COPD (GOLD), Fontana, WI, USA; British Thoracic Society Global Health Group, London, UK; Respiratory Institute, Hospital Clinic, IDIBAPS, University of Barcelona, CIBERES, Barcelona, Spain
| | - Brian W Allwood
- Division of Pulmonology, Department of Medicine, Stellenbosch University, Stellenbosch, South Africa
| | - Innes Asher
- Global Asthma Network (GAN), Auckland, New Zealand; Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Eric D Bateman
- Global Initiative for Asthma (GINA), Fontana, WI, USA; Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Karen Bissell
- Global Asthma Network (GAN), Auckland, New Zealand; School of Population Health, University of Auckland, Auckland, New Zealand
| | - Charlotte E Bolton
- British Thoracic Society Global Health Group, London, UK; NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham UK
| | - Andrew Bush
- British Thoracic Society Global Health Group, London, UK; Imperial College and Royal Brompton Hospital, London, UK
| | - Bartolome Celli
- Global Initiative for COPD (GOLD), Fontana, WI, USA; Harvard Medical School, Boston, MA, USA
| | - Chen-Yuan Chiang
- International Union Against Tuberculosis and Lung Diseases, Paris, France; Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Alvaro A Cruz
- Global Initiative for Asthma (GINA), Fontana, WI, USA; Department of Internal Medicine, Federal University of Bahia, Salvador, Brazil
| | - Anh-Tuan Dinh-Xuan
- Cochin Hospital, Université de Paris, Paris, France; European Respiratory Society, Lausanne, Switzerland
| | - Asma El Sony
- Global Asthma Network (GAN), Auckland, New Zealand; International Union Against Tuberculosis and Lung Diseases, Paris, France; Epidemiological Laboratory (EPI Lab) for Public Health and Research, Khartoum, Sudan
| | - Kwun M Fong
- The University of Queensland Thoracic Research Centre and The Prince Charles Hospital, Queensland, QLD, Australia; Asian Pacific Society of Respirology, Tokyo, Japan
| | - Paula I Fujiwara
- International Union Against Tuberculosis and Lung Diseases, Paris, France
| | - Mina Gaga
- Athens Chest Hospital Sotiria, Athens, Greece; World Health Organization, Geneva, Switzerland
| | - Luis Garcia-Marcos
- Global Asthma Network (GAN), Auckland, New Zealand; Paediatric Pulmonology and Allergy Units, Arrixaca Children's University Hospital, University of Murcia, Murcia, Spain; BioHealth Research Institute of Murcia, Murcia, Spain; ARADyAL network, Madrid, Spain
| | - David M G Halpin
- Global Initiative for COPD (GOLD), Fontana, WI, USA; University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - John R Hurst
- British Thoracic Society Global Health Group, London, UK; UCL Respiratory, University College London, London, UK
| | - Shamanthi Jayasooriya
- British Thoracic Society Global Health Group, London, UK; Academic Unit of Primary Care, University of Sheffield, Sheffield, UK
| | - Ajay Kumar
- International Union Against Tuberculosis and Lung Diseases, Paris, France
| | - Maria V Lopez-Varela
- Global Initiative for COPD (GOLD), Fontana, WI, USA; Pulmonary Department, Universidad de la Republica, Montevideo, Uruguay
| | - Refiloe Masekela
- Pan African Thoracic Society, Durban, South Africa; College of Health Sciences, Nelson R Mandela School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa
| | - Bertrand H Mbatchou Ngahane
- Pan African Thoracic Society, Durban, South Africa; International Union Against Tuberculosis and Lung Diseases, Paris, France; Douala General Hospital, Douala, Cameroon
| | - Maria Montes de Oca
- Global Initiative for COPD (GOLD), Fontana, WI, USA; Pulmonary Department, Universidad Central de Venezuela, Caracas, Venezuela
| | - Neil Pearce
- Global Asthma Network (GAN), Auckland, New Zealand; London School of Hygiene & Tropical Medicine, London, UK
| | - Helen K Reddel
- Global Initiative for Asthma (GINA), Fontana, WI, USA; Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Sundeep Salvi
- Global Initiative for COPD (GOLD), Fontana, WI, USA; Pulmocare Research and Education Foundation, Pune, India
| | - Sally J Singh
- British Thoracic Society Global Health Group, London, UK; Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Cherian Varghese
- Department of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland
| | - Claus F Vogelmeier
- Global Initiative for COPD (GOLD), Fontana, WI, USA; Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, Marburg, Germany; German Center for Lung Research (DZL), Giessen, Germany
| | - Paul Walker
- British Thoracic Society Global Health Group, London, UK; Department of Respiratory Medicine, Liverpool Teaching Hospitals, Liverpool, UK
| | - Heather J Zar
- Pan African Thoracic Society, Durban, South Africa; Department of Paediatrics & Child Health, Red Cross Childrens Hospital, Cape Town, South Africa; SA-MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Guy B Marks
- Global Asthma Network (GAN), Auckland, New Zealand; International Union Against Tuberculosis and Lung Diseases, Paris, France; Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia; UNSW Medicine, Sydney, NSW, Australia
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Cohort profile: The Chikwawa lung health cohort; a population-based observational non-communicable respiratory disease study of adults in Malawi. PLoS One 2020. [DOI: 10.1371/journal.pone.0242226
expr 968654662 + 861456751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Purpose
The aim of this article is to provide a detailed description of the Chikwawa lung health cohort which was established in rural Malawi to prospectively determine the prevalence and causes of lung disease amongst the general population of adults living in a low-income rural setting in Sub-Saharan Africa.
Participants
A total of 1481 participants were randomly identified and recruited in 2014 for the baseline study. We collected data on demographic, socio-economic status, respiratory symptoms and potentially relevant exposures such as smoking, household fuels, environmental exposures, occupational history/exposures, dietary intake, healthcare utilization, cost (medication, outpatient visits and inpatient admissions) and productivity losses. Spirometry was performed to assess lung function. At baseline, 56.9% of the participants were female, mean age was 43.8 (SD:17.8) and mean body mass index (BMI) was 21.6 Kg/m2 (SD: 3.46)
Findings to date
The cohort has reported the prevalence of chronic respiratory symptoms (13.6%, 95% confidence interval [CI], 11.9–15.4), spirometric obstruction (8.7%, 95% CI, 7.0–10.7), and spirometric restriction (34.8%, 95% CI, 31.7–38.0). Additionally, an annual decline in forced expiratory volume in one second [FEV1] of 30.9mL/year (95% CI: 21.6 to 40.1) and forced vital capacity [FVC] by 38.3 mL/year (95% CI: 28.5 to 48.1) has been reported.
Future plans
The ongoing phases of follow-up will determine the annual rate of decline in lung function as measured through spirometry and the development of airflow obstruction and restriction, and relate these to morbidity, mortality and economic cost of airflow obstruction and restriction. Population-based mathematical models will be developed driven by the empirical data from the cohort and national population data for Malawi to assess the effects of interventions and programmes to address the lung burden in Malawi. The present follow-up study started in 2019.
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Njoroge MW, Rylance S, Nightingale R, Gordon S, Mortimer K, Burney P, Rylance J, Obasi A, Niessen L, Devereux G. Cohort profile: The Chikwawa lung health cohort; a population-based observational non-communicable respiratory disease study of adults in Malawi. PLoS One 2020; 15:e0242226. [PMID: 33180873 PMCID: PMC7660567 DOI: 10.1371/journal.pone.0242226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 10/28/2020] [Indexed: 01/09/2023] Open
Abstract
PURPOSE The aim of this article is to provide a detailed description of the Chikwawa lung health cohort which was established in rural Malawi to prospectively determine the prevalence and causes of lung disease amongst the general population of adults living in a low-income rural setting in Sub-Saharan Africa. PARTICIPANTS A total of 1481 participants were randomly identified and recruited in 2014 for the baseline study. We collected data on demographic, socio-economic status, respiratory symptoms and potentially relevant exposures such as smoking, household fuels, environmental exposures, occupational history/exposures, dietary intake, healthcare utilization, cost (medication, outpatient visits and inpatient admissions) and productivity losses. Spirometry was performed to assess lung function. At baseline, 56.9% of the participants were female, mean age was 43.8 (SD:17.8) and mean body mass index (BMI) was 21.6 Kg/m2 (SD: 3.46). FINDINGS TO DATE The cohort has reported the prevalence of chronic respiratory symptoms (13.6%, 95% confidence interval [CI], 11.9-15.4), spirometric obstruction (8.7%, 95% CI, 7.0-10.7), and spirometric restriction (34.8%, 95% CI, 31.7-38.0). Additionally, an annual decline in forced expiratory volume in one second [FEV1] of 30.9mL/year (95% CI: 21.6 to 40.1) and forced vital capacity [FVC] by 38.3 mL/year (95% CI: 28.5 to 48.1) has been reported. FUTURE PLANS The ongoing phases of follow-up will determine the annual rate of decline in lung function as measured through spirometry and the development of airflow obstruction and restriction, and relate these to morbidity, mortality and economic cost of airflow obstruction and restriction. Population-based mathematical models will be developed driven by the empirical data from the cohort and national population data for Malawi to assess the effects of interventions and programmes to address the lung burden in Malawi. The present follow-up study started in 2019.
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Affiliation(s)
- Martin W. Njoroge
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Malawi Liverpool Wellcome Trust Programme, Blantyre, Malawi
| | - Sarah Rylance
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Malawi Liverpool Wellcome Trust Programme, Blantyre, Malawi
| | - Rebecca Nightingale
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Malawi Liverpool Wellcome Trust Programme, Blantyre, Malawi
| | - Stephen Gordon
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Malawi Liverpool Wellcome Trust Programme, Blantyre, Malawi
| | - Kevin Mortimer
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Peter Burney
- National heart and Lung Institute, Imperial College, London, United Kingdom
| | - Jamie Rylance
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Malawi Liverpool Wellcome Trust Programme, Blantyre, Malawi
| | - Angela Obasi
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Louis Niessen
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- John Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Graham Devereux
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Wroe EB, Kalanga N, Dunbar EL, Nazimera L, Price NF, Shah A, Dullie L, Mailosi B, Gonani G, Ndarama EPL, Talama GC, Bukhman G, Kerr L, Connolly E, Kachimanga C. Expanding access to non-communicable disease care in rural Malawi: outcomes from a retrospective cohort in an integrated NCD-HIV model. BMJ Open 2020; 10:e036836. [PMID: 33087368 PMCID: PMC7580053 DOI: 10.1136/bmjopen-2020-036836] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 09/25/2020] [Accepted: 10/03/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Non-communicable diseases (NCDs) account for one-third of disability-adjusted life years in Malawi, and access to care is exceptionally limited. Integrated services with HIV are widely recommended, but few examples exist globally. We report descriptive outcomes from an Integrated Chronic Care Clinic (IC3). DESIGN This is a retrospective cohort study. SETTING The study includes an HIV-NCD clinic across 14 primary care facilities in the rural district of Neno, Malawi. PARTICIPANTS All new patients, including 6233 HIV-NCD diagnoses, enrolled between January 2015 and December 2017 were included. This included 3334 patients with HIV (59.7% women) and 2990 patients with NCD (67.3% women), 10% overall under age 15 years. INTERVENTIONS Patients were seen at their nearest health centre, with a hospital team visiting routinely to reinforce staffing. Data were collected on paper forms and entered into an electronic medical record. PRIMARY AND SECONDARY OUTCOME MEASURES Routine clinical measurements are reported at 1-year post-enrolment for patients with more than one visit. One-year retention is reported by diagnosis. RESULTS NCD diagnoses were 1693 hypertension, 668 asthma, 486 epilepsy, 149 diabetes and 109 severe mental illness. By December 2018, 8.3% of patients with NCD over 15 years were also on HIV treatment. One-year retention was 85% for HIV and 72% for NCDs, with default in 8.4% and 25.5% and deaths in 4.0% and 1.4%, respectively. Clinical outcomes showed statistically significant improvement for hypertension, diabetes, asthma and epilepsy. Of the 1807 (80%) of patients with HIV with viral load results, 85% had undetectable viral load. CONCLUSIONS The IC3 model, built on an HIV platform, facilitated rapid decentralisation and access to NCD services in rural Malawi. Clinical outcomes and retention in care are favourable, suggesting that integration of chronic disease care at the primary care level poses a way forward for the large dual burden of HIV and chronic NCDs.
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Affiliation(s)
- Emily B Wroe
- Partners In Health, Neno, Malawi
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Noel Kalanga
- Department of Health Systems and Policy, College of Medicine, Blantyre, Malawi
| | | | - Lawrence Nazimera
- Ministry of Health, Neno District Health Office, Ministry of Health, Neno, Malawi
| | | | - Adarsh Shah
- Partners In Health, Boston, Massachusetts, USA
| | | | | | - Grant Gonani
- Ministry of Health, Neno District Health Office, Ministry of Health, Neno, Malawi
| | - Enoch P L Ndarama
- Ministry of Health, Neno District Health Office, Ministry of Health, Neno, Malawi
| | | | - Gene Bukhman
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Masekela R, Vanker A. Lung Health in Children in Sub-Saharan Africa: Addressing the Need for Cleaner Air. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6178. [PMID: 32858786 PMCID: PMC7504680 DOI: 10.3390/ijerph17176178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 11/17/2022]
Abstract
Air pollution is increasingly recognized as a global health emergency with its impacts being wide ranging, more so for low- and middle-income countries where both indoor and outdoor pollution levels are high. In Africa, more than 80% of children live in households which use unclean sources of energy. The effects of both indoor and outdoor pollution on lung health on children who are the most vulnerable to their effects range from acute lower respiratory tract infections to long-term chronic health effects. We reviewed the literature on the effects of air pollution in children in Sub-Saharan Africa from prenatal exposure, infancy and school-going children. Data from Sub-Saharan Africa on quantification of exposures both indoor and outdoor mainly utilizes modelling or self-reporting. Exposures to biomass not only increases the risk of acute respiratory tract infections in young children but also increases the risk of carriage of pathogenic bacteria in the upper respiratory tract. Although there is limited evidence of association between asthma and pollution in African children, airway hyper-responsiveness and lower lung function has been demonstrated in children with higher risk of exposure. Interventions at a policy level to both quantify the exposure levels at a population level are urgently needed to address the possible interventions to limit exposure and improve lung health in children in Sub-Saharan Africa.
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Affiliation(s)
- Refiloe Masekela
- Department of Paediatrics and Child Health, Nelson R Mandela School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban 4013, South Africa
| | - Aneesa Vanker
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town 7700, South Africa;
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Mortimer K, Lesosky M, Semple S, Malava J, Katundu C, Crampin A, Wang D, Weston W, Pope D, Havens D, Gordon SB, Balmes J. Pneumonia and Exposure to Household Air Pollution in Children Under the Age of 5 Years in Rural Malawi: Findings From the Cooking and Pneumonia Study. Chest 2020; 158:501-511. [PMID: 32311349 PMCID: PMC7417377 DOI: 10.1016/j.chest.2020.03.064] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/16/2020] [Accepted: 03/28/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Exposure to household air pollution is associated with an increased risk of pneumonia in children in low- and middle-income countries; however, exposure-response data are limited, and there are uncertainties around the extent to which biomass-fueled cookstoves can reduce these exposures. RESEARCH QUESTION What is the association between exposure to household air pollution and pneumonia in children under the age of 5 years in rural Malawi and what are the effects of a biomass-fueled cookstove intervention on personal exposure to household air pollution? STUDY DESIGN AND METHODS We measured personal exposure to carbon monoxide (CO; 48 hours of continuous measurement and transcutaneous carboxyhemoglobin) every 6 months in children who participated in a cluster-randomized controlled trial of a cleaner burning biomass-fueled cookstove intervention to prevent pneumonia in children under the age of 5 years in rural Malawi (the Cooking And Pneumonia Study). Exposure-response and multivariable analyses were done. RESULTS We recruited 1805 (928 intervention; 877 control) children (mean age, 25.6 months; 50.6% female). We found no evidence of an association between exposure to CO (incident rate ratio, 1.0; 95% CI, 0.967 to 1.014; P = .53) or carboxyhemoglobin (incident rate ratio, 1.00; 95% CI, 0.993 to 1.003; P = .41) in children who experienced pneumonia vs those who did not. Median exposure to CO in the intervention and control groups was was 0.34 (interquartile range, 0.15 to 0.81) and 0.37 parts per million (interquartile range, 0.15 toa 0.97), respectively. The group difference in means was 0.46 (95% CI, -0.95 to 0.012; P = .06). INTERPRETATION Exposure to CO in our population was low with no association seen between exposure to CO and pneumonia incidence and no effect of the Cooking And Pneumonia Study intervention on these exposures. These findings suggest that CO may not be an appropriate measure of household air pollution exposure in settings such as rural Malawi and that there is a need to develop ways to measure particulate matter exposures directly in young children instead. CLINICAL TRIAL REGISTRATION ISRCTN59448623.
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Affiliation(s)
| | - Maia Lesosky
- University of Cape Town, Cape Town, South Africa
| | | | - Jullita Malava
- Malawi Epidemiology and Intervention Research Unit, Chilumba, Malawi
| | - Cynthia Katundu
- Malawi Epidemiology and Intervention Research Unit, Chilumba, Malawi
| | - Amelia Crampin
- Malawi Epidemiology and Intervention Research Unit, Chilumba, Malawi; London School of Hygiene and Tropical Medicine, London, UK
| | - Duolao Wang
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Dan Pope
- University of Liverpool, Liverpool, UK
| | | | - Stephen B Gordon
- Liverpool School of Tropical Medicine, Liverpool, UK; Malawi Liverpool Wellcome Trust Programme, Blantyre, Malawi
| | - John Balmes
- University of California, Berkeley, CA; University of California, San Francisco, San Francisco, CA
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Duan RR, Hao K, Yang T. Air pollution and chronic obstructive pulmonary disease. Chronic Dis Transl Med 2020; 6:260-269. [PMID: 33336171 PMCID: PMC7729117 DOI: 10.1016/j.cdtm.2020.05.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Indexed: 01/01/2023] Open
Abstract
There is considerable epidemiological evidence indicating that air pollution has adverse effects on human health and is closely related to respiratory diseases, including chronic obstructive pulmonary disease (COPD). These effects, which can be divided into short- and long-term effects, can manifest as an exacerbation of existing symptoms, impaired lung function, and increased hospitalization and mortality rates. Long-term exposure to air with a high concentration of pollutants may also increase the incidence of COPD. The combined effects of different pollutants may become more complex in the future; hence, there is a need for more intensive research on specific at-risk populations, and formulating corresponding protective strategies is crucial. We aimed to review the epidemiological evidence on the effect of air pollution on COPD, the possible pathophysiological mechanisms underlying this effect, as well as protective measures against the effects of air pollutants in patients with COPD.
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Affiliation(s)
- Rui-Rui Duan
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China.,Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China.,National Clinical Research Center for Respiratory Diseases, Beijing 100029, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing 100029, China
| | - Ke Hao
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Ting Yang
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China.,Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China.,National Clinical Research Center for Respiratory Diseases, Beijing 100029, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing 100029, China
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Mosler G, Oyenuga V, Addo-Yobo E, Adeyeye OO, Masekela R, Mujuru HA, Nantanda R, Rylance S, Ticklay I, Grigg J. Achieving Control of Asthma in Children in Africa (ACACIA): protocol of an observational study of children's lung health in six sub-Saharan African countries. BMJ Open 2020; 10:e035885. [PMID: 32193275 PMCID: PMC7202730 DOI: 10.1136/bmjopen-2019-035885] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Little is known about asthma control in the rising number of African children who suffer from this condition. The Achieving Control of Asthma in Children in Africa (ACACIA) study is an observational study collecting evidence about paediatric asthma in urban areas of Ghana, Malawi, Nigeria, South Africa, Uganda and Zimbabwe. The primary objectives are: (1) to identify 3000 children aged between 12 years and 14 years with asthma symptoms; and (2) to assess their asthma control, current treatment, knowledge of and attitudes to asthma and barriers to achieving good control. Secondary objective is to develop interventions addressing identified barriers to good symptom control. METHODS AND ANALYSIS Each centre will undertake screening to identify 500 school children with asthma symptoms using questions from the Global Asthma Network's questionnaire. Children identified to have asthma symptoms will fill in a digital survey, including: Asthma Control Test, questions on medication usage and adherence, medical care, the Brief-Illness Perception questionnaire and environmental factors. Exhaled nitric oxide testing and prebronchodilator and postbronchodilator spirometry will be performed. A subgroup of children will participate in focus group discussions. Results will be analysed using descriptive statistics and comparative analysis. Informed by these results, we will assess the feasibility of potential interventions, including the adaption of a UK-based theatre performance about asthma attitudes and digital solutions to improve asthma management. ETHICS AND DISSEMINATION The ACACIA study has been reviewed by the Queen Mary University of London Ethics of Research Committee in the UK. All African centres have received local ethical approval for this study. Study results will be published in academic journals and at conferences. Study outputs will be communicated to the public via newsfeeds on the ACACIA website and Twitter, and through news media outlets and other local dissemination. TRIAL REGISTRATION NUMBER 269211.
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Affiliation(s)
- Gioia Mosler
- Centre for Genomics and Child Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Victoria Oyenuga
- Centre for Genomics and Child Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Emmanuel Addo-Yobo
- School of Medicine and Dentistry, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Refiloe Masekela
- Paediatrics and Child Health, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | | | - Rebecca Nantanda
- Lung Institute, Makerere College of Health Sciences, Makerere University, Kampala, Uganda
| | - Sarah Rylance
- Malawi-Liverpool -Wellcome (MLW) Trust Clinical Research Programme, Wellcome Trust, Blantyre, Malawi
| | - Ismail Ticklay
- College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Jonathan Grigg
- Centre for Genomics and Child Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Rylance S, Jewell C, Naunje A, Mbalume F, Chetwood JD, Nightingale R, Zurba L, Flitz G, Gordon SB, Lesosky M, Balmes JR, Mortimer K. Non-communicable respiratory disease and air pollution exposure in Malawi: a prospective cohort study. Thorax 2020; 75:220-226. [PMID: 32079666 PMCID: PMC7063402 DOI: 10.1136/thoraxjnl-2019-213941] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 12/09/2019] [Accepted: 01/06/2020] [Indexed: 01/01/2023]
Abstract
RATIONALE There are no population-based studies from sub-Saharan Africa describing longitudinal lung function in adults. OBJECTIVES To explore the lung function trajectories and their determinants, including the effects of air pollution exposures and the cleaner-burning biomass-fuelled cookstove intervention of the Cooking and Pneumonia Study (CAPS), in adults living in rural Malawi. METHODS We assessed respiratory symptoms and exposures, spirometry and measured 48-hour personal exposure to fine particulate matter (PM2.5) and carbon monoxide (CO), on three occasions over 3 years. Longitudinal data were analysed using mixed-effects modelling by maximum likelihood estimation. MEASUREMENTS AND MAIN RESULTS We recruited 1481 adults, mean (SD) age 43.8 (17.8) years, including 523 participants from CAPS households (271 intervention; 252 controls), and collected multiple spirometry and air pollution measurements for 654 (44%) and 929 (63%), respectively. Compared with Global Lung Function Initiative African-American reference ranges, mean (SD) FEV1 (forced expiratory volume in 1 s) and FVC (forced vital capacity) z-scores were -0.38 (1.14) and -0.19 (1.09). FEV1 and FVC were determined by age, sex, height, previous TB and body mass index, with FEV1 declining by 30.9 mL/year (95% CI: 21.6 to 40.1) and FVC by 38.3 mL/year (95% CI: 28.5 to 48.1). There was decreased exposure to PM2.5 in those with access to a cookstove but no effect on lung function. CONCLUSIONS We did not observe accelerated lung function decline in this cohort of Malawian adults, compared with that reported in healthy, non-smoking populations from high-income countries; this suggests that the lung function deficits we measured in adulthood may have origins in early life.
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Affiliation(s)
- Sarah Rylance
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Lung Health Group, Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | | | - Andrew Naunje
- Lung Health Group, Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Frank Mbalume
- Lung Health Group, Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - John D Chetwood
- John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Rebecca Nightingale
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Lindsay Zurba
- Education for Health Africa, Vereeniging, South Africa
| | - Graham Flitz
- School of Public Health, University of California, Berkeley, California, USA
| | - Stephen B Gordon
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Lung Health Group, Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Maia Lesosky
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Rondebosch, Cape Town, South Africa
| | - John R Balmes
- School of Public Health, University of California, Berkeley, California, USA
- Environmental Health Sciences Division, University of California San Francisco, San Francisco, California, USA
| | - Kevin Mortimer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
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Goh DYT, Mun MW, Lee WLJ, Teoh OH, Rajgor DD. A randomised clinical trial to evaluate the safety, fit, comfort of a novel N95 mask in children. Sci Rep 2019; 9:18952. [PMID: 31831801 PMCID: PMC6908682 DOI: 10.1038/s41598-019-55451-w] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/20/2019] [Indexed: 01/08/2023] Open
Abstract
Children are more vulnerable to the risks of air pollution, including susceptibility to acquiring chronic diseases in their developing lungs. Despite these, there are no specific masks designed for and tested in children that are available to protect our young from the common particulate air pollutants today. We evaluated safety, fit and comfort of a specially designed paediatric N95 mask with an optional micro ventilator (micro fan, MF) in healthy children aged 7-14 years, in a randomized, two-period crossover design. The subjects' cardiorespiratory physiological measurements were assessed in different states of physical activity under different interventions (mask without and with MF). A total of 106 subjects were recruited between July-August 2016. The use of the mask without MF increased the End-Tidal CO2 (ETCO2) and Fractional concentration of Inspired CO2 (FICO2) at rest and on mild exertion, as expected. The use of the mask with MF brought FICO2 levels comparably closer to baseline levels without the mask for both activities. The mask, with or without the MF, was found to be well fitting, comfortable and safe for use in children at rest and on mild exertion. The N95 mask tested offers a promising start for more studies in the paediatric population.
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Affiliation(s)
- Daniel Yam Thiam Goh
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore.
| | | | | | - Oon Hoe Teoh
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Dimple D Rajgor
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
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Moschovis PP, Hibberd PL. Household air pollution-related lung disease: protecting the children. Thorax 2019; 74:1018-1019. [PMID: 31615928 PMCID: PMC6995330 DOI: 10.1136/thoraxjnl-2019-214134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Peter P Moschovis
- Divisions of Pulmonary Medicine and Global Health, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Patricia L Hibberd
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
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