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Alenezi A, Qureshi H, Ahmed OG, Ramanathan M. Air Quality, Allergic Rhinitis, and Asthma. Otolaryngol Clin North Am 2024; 57:293-307. [PMID: 37985273 DOI: 10.1016/j.otc.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
This review article highlights air pollution as a critical global health concern with emphasis on its effects and role in the development and exacerbation of upper airway and lower airway disease with a focus on allergic rhinitis and asthma. This review underscores the World Health Organization's recognition of air pollution as the biggest environmental threat to human health. It discusses the various components and categories of air pollutants and the evidence-based effects they have on asthma and allergic rhinitis, ranging from pathogenesis to exacerbation of these conditions across various age groups in different geographic locations.
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Affiliation(s)
- Abdulrahman Alenezi
- Department of Otolaryngology- Head and Neck Surgery, Johns Hopkins School of Medicine, Johns Hopkins Outpatient Center, 6th Floor, 601 North Caroline Street, Baltimore, MD 21287-0910, USA
| | - Hannan Qureshi
- Department of Otolaryngology- Head and Neck Surgery, Johns Hopkins School of Medicine, Johns Hopkins Outpatient Center, 6th Floor, 601 North Caroline Street, Baltimore, MD 21287-0910, USA
| | - Omar G Ahmed
- Academic Institute, Houston, TX 77030, USA; Research Institute, Otolaryngology-Head and Neck Surgery, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Murugappan Ramanathan
- Department of Otolaryngology- Head and Neck Surgery, Johns Hopkins School of Medicine, Johns Hopkins Outpatient Center, 6th Floor, 601 North Caroline Street, Baltimore, MD 21287-0910, USA.
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Mulat E, Tamiru D, Abate KH. Impact of indoor Air Pollution on the Linear growth of children in Jimma, Ethiopia. BMC Public Health 2024; 24:488. [PMID: 38365615 PMCID: PMC10870508 DOI: 10.1186/s12889-024-17975-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/03/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Stunting in children is the term for reduced linear growth and development, which is frequently brought on by a persistently inadequate diet, recurrent infections and chronic diseases or poor health conditions. Apart from the classic covariates of stunting, which include diet and illness, the relative contribution of household air pollution to chronic nutrition conditions is least studied. Hence, this study is conducted to investigate the impact of household air pollution on the linear growth of under-five children in Jimma town, Ethiopia. METHODS A prospective cohort study was employed to collect data from 280 under-five children who lived in households using solid fuel (exposed group, n = 140) and clean fuel (unexposed group, n = 140). Height-for-age Z scores were compared in both groups over a 12-month follow-up period. The difference in differences estimators were used for comparison of changes in the height-for-age Z scores from baseline to end line in exposed and non-exposed groups. The independent effect of the use of solid fuels on height-for-age Z scores was analyzed through a multivariable linear regression model. Statistical Significances were declared at P < 0.05 and 95% CI level. RESULTS In an unadjusted model (Model 1), compared with the clean fuel type, the mean difference in the height-for-age Z score of children in households using solid fuel was lower by 0.54 (-0.54, 95% CI -0.97, -0.12, P = 0.011). The beta coefficient remained negative after adjusting for age and sex (Model 2 -0.543, 95% CI -1.373, -0.563) and sociodemographic variables (Model 3: -0.543, 95% CI -1.362, -0.575). In the final model (Model 4), which adjusted for wealth quantile, dietary practice, water, sanitation and hygiene status and household food insecurity access scale, the beta coefficient held the same and significant (beta: -0.543, 95% CI -1.357, -0.579, P < 0.001). Higher HAZ scores were observed among female child (β: = 0.48, 95%CI: 0.28, 0.69), Child with father attended higher education (β: = 0.304 95%CI: 0.304, 95% CI 0.19, 0.41) as compared to male gender and those who did not attend a formal education, respectively. In contrast, child living in households with poor hygiene practices had lower HAZ score (β: -0.226, 95% CI: -0.449, -0.003), P < 0.001. CONCLUSIONS Exposure to indoor air pollution was inversely related to linear growth. Furthermore, sex, educational status and hygiene were found relevant predictors of linear growth. In such a setting, there is a need to step up efforts to design and implement public education campaigns regarding the health risks associated with exposure to household air pollution. Promoting improvements to kitchen ventilation and the use of improved cooking stoves, which will help to mitigate the detrimental effects of indoor air pollution on child growth impairment and its long-term effects.
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Affiliation(s)
- Elias Mulat
- Department of Biomedical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia.
| | - Dessalegn Tamiru
- Department of Nutrition and Dietetics, Food and Nutrition Research Institute, Jimma University, Jimma, Ethiopia
| | - Kalkidan Hassen Abate
- Department of Nutrition and Dietetics, Food and Nutrition Research Institute, Jimma University, Jimma, Ethiopia
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Dwivedi S, Zehra F, Masih J, Gupta T, Lawrence A. Investigating the temporal dynamics of sub-micron particles and particle-bound transition metals in indoor air of a metropolitan city. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2024; 46:49. [PMID: 38227135 DOI: 10.1007/s10653-023-01786-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 11/13/2023] [Indexed: 01/17/2024]
Abstract
The present study portrays an association between particle-bound transition metals and children's health. The indoor air quality of the urban metropolitan city households was monitored for four PM sizes, namely PM1.0-2.5, PM0.50-1.0, PM0.25-0.50 and PM<0.25, in major seasons observed in the city; summer and winter. Further transition/heavy metals, viz. Cr, Cu, Fe, Mn, Ni, Pb and Zn, were analysed in PM1-2.5 samples. In order to evaluate the effect, health risk assessment was performed using mathematical and computational model for assessing dermal exposure and dose estimation (multiple path particle dosimetry model version3.0). The study principally targeted the children aged 2-15 years for the health risk assessment. According to the results, for the largest particle size i.e. PM1.0-2.5 the highest deposition was in the head region (49.1%) followed by pulmonary (43.6%) and tracheobronchial region (7.2%), whereas, for the smallest particle size i.e. PM<0.25 the highest deposition was obtained in the pulmonary region (73.0%) followed by the head (13.6%) and TB region (13.2%). Also, the most imperilled group of children with highest dose accumulation was found to be children aged 8-9 years for all particle sizes. Moreover, the dermal exposure dose as evaluated was found to be preeminent for Ni, Zn and Pb. Besides, seasonal variation gesticulated towards elevated concentrations in winter relative to the summer season. Altogether, the study will provide a conception to the researchers in the fields mounting season-specific guidelines and mitigation approaches. Conclusively, the study commends future work focussing on defining the effects of other chemical components on particles and associated transition metal composition along with proper extenuation of the same.
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Affiliation(s)
- Samridhi Dwivedi
- Department of Chemistry, Isabella Thoburn College, Lucknow, India
| | - Farheen Zehra
- Department of Chemistry, Isabella Thoburn College, Lucknow, India
| | - Jamson Masih
- Department of Chemistry, Wilson College, Mumbai, India
| | - Tarun Gupta
- Department of Civil Engineering, Indian Institute of Technology, Kanpur, India
| | - Alfred Lawrence
- Department of Chemistry, Isabella Thoburn College, Lucknow, India.
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Lu W, Jenny A, Romero C, Diaz-Artiga A, Kuster A, Canuz E, Pillarisetti A, McCracken JP, Huang W, Smith KR, Balmes J, Thompson LM. Biomass smoke exposure and somatic growth among children: The RESPIRE and CRECER prospective cohort studies in rural Guatemala. ENVIRONMENT INTERNATIONAL 2024; 183:108401. [PMID: 38147790 DOI: 10.1016/j.envint.2023.108401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/11/2023] [Accepted: 12/20/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Cooking-related biomass smoke is a major source of household air pollution (HAP) and an important health hazard. Prior studies identified associations between HAP exposure and childhood stunting; less is known for underweight and wasting. Few studies had personal HAP measurements. METHODS 557 households in rural Guatemala were enrolled in the CRECER study, the follow-up study of the RESPIRE randomized intervention trial. They were assigned to three groups that received chimney stoves at different ages of the study children. Multiple personal carbon monoxide (CO) exposure measurements were used as proxies for HAP exposures. Children's heights and weights were measured from 24 to 60 months of age. Height-for-age z-score (HAZ), weight-for-age z-score (WAZ), and weight-for-height z-score (WHZ) were calculated based on the World Health Organization's Multicentre Growth Reference Study. HAZ, WAZ, and WHZ below -2 were classified as stunting, underweight, and wasting, respectively. Generalized linear models and mixed effects models were applied. RESULTS 541 children had valid anthropometric data, among whom 488 (90.2 %) were stunted, 192 (35.5 %) were underweight, and 2 (0.3 %) were wasted. A 1 ppm higher average CO exposure was associated with a 0.21 lower HAZ (95 % CI: 0.17-0.25), a 0.13 lower WAZ (95 % CI: 0.10-0.17) and a 0.06 lower WHZ (95 % CI: 0.02-0.10).The associations for HAZ were stronger among boys (coefficient = -0.29, 95 % CI: -0.35 - -0.22) than among girls (coefficient = -0.15, 95 % CI: -0.20 - -0.10). A 1 ppm-year higher cumulative CO exposure was associated with a higher risk of moderate stunting among boys (OR = 1.27, 95 % CI: 1.05-1.59), but not among girls. DISCUSSION In this rural Guatemalan population, higher HAP exposure was associated with lower HAZ and WAZ. The associations between HAP and HAZ/stunting were stronger among boys. Reducing HAP might benefit childhood somatic growth in rural populations of low-income countries.
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Affiliation(s)
- Wenxin Lu
- School of Public Health, University of California, Berkeley, 94720 Berkeley, CA, USA.
| | - Alisa Jenny
- Institute for Global Health Sciences, University of California, San Francisco, 94158 San Francisco, CA, USA.
| | - Carolina Romero
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
| | - Anaite Diaz-Artiga
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
| | - Andrea Kuster
- School of Nursing, University of California, San Francisco, 94158 San Francisco, CA, USA.
| | - Eduardo Canuz
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
| | - Ajay Pillarisetti
- School of Public Health, University of California, Berkeley, 94720 Berkeley, CA, USA.
| | - John P McCracken
- Epidemiology and Biostatistics Department, University of Georgia, 30606 Athens, GA, USA.
| | - Wenzhong Huang
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Kirk R Smith
- School of Public Health, University of California, Berkeley, 94720 Berkeley, CA, USA
| | - John Balmes
- School of Public Health, University of California, Berkeley, 94720 Berkeley, CA, USA; Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Lisa M Thompson
- Nell Hodgson Woodruff School of Nursing, Emory University, 30322 Atlanta, GA, USA.
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Lee E, Lee SY, Kim HB, Yang SI, Yoon J, Suh DI, Oh HY, Ahn K, Kim KW, Shin YH, Hong SJ. Insights from the COCOA birth cohort: The origins of childhood allergic diseases and future perspectives. Allergol Int 2024; 73:3-12. [PMID: 37752021 DOI: 10.1016/j.alit.2023.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 08/31/2023] [Indexed: 09/28/2023] Open
Abstract
The ongoing COhort for Childhood Origin of Asthma and allergic diseases (COCOA) study is a prospective birth cohort investigating the origin and natural courses of childhood allergic diseases, including atopic dermatitis, food allergy, allergic rhinitis and asthma, with long-term prognosis. Initiated under the premise that allergic diseases result from a complex interplay of immune development alterations, environmental exposures, and host susceptibility, the COCOA study explores these dynamic interactions during prenatal and postnatal periods, framed within the hygiene and microbial hypotheses alongside the developmental origins of health and disease (DOHaD) hypothesis. The scope of the COCOA study extends to genetic predispositions, indoor and outdoor environmental variables affecting mothers and their offsprings such as outdoor and indoor air pollution, psychological factors, diets, and the microbiomes of skin, gut, and airway. We have embarked on in-depth investigations of diverse risk factors and the pathophysiological underpinnings of allergic diseases. By employing multi-omics approaches-proteomics, transcriptomics, and metabolomics-we gain deeper insights into the distinct pathophysiological processes across various endotypes of childhood allergic diseases, incorporating the exposome using extensive resources within the COCOA study. Integration with large-scale datasets, such as national health insurance records, enhances robustness and mitigates potential limitations inherent to birth cohort studies. As part of global networks focused on childhood allergic diseases, the COCOA study fosters collaborative research across multiple cohorts. The findings from the COCOA study are instrumental in informing precision medicine strategies for childhood allergic diseases, underpinning the establishment of disease trajectories.
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Affiliation(s)
- Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - So-Yeon Lee
- Department of Pediatrics, Childhood Asthma Atopy Center, Humidifier Disinfectant Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyo-Bin Kim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, South Korea
| | - Song-I Yang
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Jisun Yoon
- Department of Pediatrics, Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Hea Young Oh
- Department of Medicine, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kangmo Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyung Won Kim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Youn Ho Shin
- Department of Pediatrics, The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul, South Korea
| | - Soo-Jong Hong
- Department of Pediatrics, Childhood Asthma Atopy Center, Humidifier Disinfectant Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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Mimura T, Ichinose T, Inoue KI, Yoshida Y, Fujishima H. Airborne Suspended Particulate Matter and the Prevalence of Allergic Conjunctivitis in Japan. Cureus 2024; 16:e53292. [PMID: 38435920 PMCID: PMC10906130 DOI: 10.7759/cureus.53292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Background This study aimed to examine the association of suspended particulate matter (SPM) with outpatient attendance for allergic conjunctivitis. Methodology The information on air pollution, encompassing total hydrocarbons, non-methane hydrocarbons, methane, carbon monoxide, nitrogen oxide, nitric oxide, oxidants, and SPM alongside data concerning daily weather conditions such as temperature, wind speed, and humidity, was gathered. Subsequently, the weekly mean values for outpatient visits, air pollution, and weather parameters were computed. Results The number of outpatient visits for allergic conjunctivitis was significantly associated with SPM levels (r = 0.70, p = 0.0037), oxidant levels (r = 0.70, p = 0.0038), wind speed (r = 0.48, p = 0.0472), and humidity (r = 0.77, p = 0.0009) from January to March, as well as SPM levels (r = 0.53, p = 0.0309) and carbon monoxide (r = 0.56, p = 0.0230) from April to June. Multivariate analysis showed that SPM (odds ratio = 1.37, p = 0.0161) and wind velocity (odds ratio = 1.52, p = 0.0038) were significant predictors of the number of outpatient visits from January to December. Conclusions SPM levels were the only independent predictor of outpatient visits for allergic conjunctivitis, suggesting that SPM contributes to the pathophysiology of this condition.
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Affiliation(s)
- Tatsuya Mimura
- Ophthalmology, Teikyo University School of Medicine, Tokyo, JPN
| | - Takamichi Ichinose
- Department of Health Science, Oita University of Nursing and Health Sciences, Oita, JPN
| | - Ken-Ichiro Inoue
- Graduate School of Nursing, University of Shizuoka, Shizuoka, JPN
| | - Yasuhiro Yoshida
- Department of Immunology and Parasitology, School of Medicine, University of Occupational and Environmental Health, Fukuoka, JPN
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Singh S, Kulshrestha MR, Pathak AK, Srivastava S, Singh A, Tiwari V. Transfluthrin is Associated with High Susceptibility to Asthma in Children with Promoter Variants of Beta Chain of High-Affinity Receptor IgE and Tumour Necrosis Factors-α Genes. Biochem Genet 2023:10.1007/s10528-023-10555-x. [PMID: 37980703 DOI: 10.1007/s10528-023-10555-x] [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: 06/10/2023] [Accepted: 10/20/2023] [Indexed: 11/21/2023]
Abstract
This study investigates the genetic variations in FcεR1β-109 C/T (rs512555) and TNF-α-308 G/A (rs1800629) genes and examines whether the mosquito repellent transfluthrin (TFT) modifies the risk for asthmatic children. A case-control study was conducted involving 130 asthmatic children and 123 age-sex matched controls. Differential leukocyte counts, IgE, and hs-CRP levels were estimated using a five-part haematology analyzer and Beckman Coulter (AU480), respectively. Genetic variations in FcεR1β-109 and TNF-α-308 were analysed using restriction fragment length polymorphism. Serum TFT levels were measured using gas chromatography-tandem mass spectrometry. Asthmatic children had significantly increased total leukocyte, neutrophil, lymphocyte, eosinophil, and basophil counts (p < 0.0001), while their monocyte counts were lower compared to controls (p < 0.0001). TFT levels were higher in asthmatic children (1.38 ± 0.91 vs. control 0.69 ± 0.41µg/L, p < 0.0001), which predominantly induced wheezing. Elevated TFT levels were associated with an increased risk of childhood asthma (OR: 3.08, p < 0.0001). Children with the FcεRIβ TT (OR: 2.39, p < 0.017) and TNF-α GG genotypes (OR: 7.17, p < 0.0001) were more susceptible to asthma. TFT synergistically enhanced the risk of asthma in both FcεRIβ-109 TT (OR: 5.3, p = 0.001) and TNF-α-308 GG (OR: 17.18, p < 0.0001) genotypes. TFT levels were correlated with IgE (r = 0.363; p = 0.006), hs-CRP (r = 0.324; p = 0.049) and eosinophil (r = 0.300; p = 0.038), respectively. IgE and eosinophils were correlated (r = 0.599, p = 0.001) in the FcεRIβ TT genotype-carrying asthmatic children. Similarly, neutrophils and hs-CRP were correlated (r = 0.768, p < 0.0001) in asthmatic children with TNF-α GG genotype. The risk of asthma is inherently higher in children with FcεRIβ TT and TNF-α GG variants. TFT exposure amplifies the risk of asthma in children among all the subgenotypes of both genes. TFT influences IgE and eosinophil in FcεRIβ TT genotype while it influences neutrophils and hs-CRP in TNF-α GG genotypes.
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Affiliation(s)
- Shivani Singh
- Amity Institute of Biotechnology, Amity University Uttar Pradesh, Lucknow Campus, Lucknow, Uttar Pradesh, 226028, India
- Department of Biochemistry, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226010, India
| | - Manish Raj Kulshrestha
- Department of Biochemistry, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226010, India
| | - Anumesh K Pathak
- Department of Biochemistry, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226010, India
| | - Shetanshu Srivastava
- Department of Pediatrics, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226010, India
| | - Aditi Singh
- Amity Institute of Biotechnology, Amity University Uttar Pradesh, Lucknow Campus, Lucknow, Uttar Pradesh, 226028, India
| | - Vandana Tiwari
- Department of Biochemistry, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226010, India.
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Huang HC, Zou ML, Chen YH, Jiang CB, Wu CD, Lung SCC, Chien LC, Lo YC, Chao HJ. Effects of indoor air quality and home environmental characteristics on allergic diseases among preschool children in the Greater Taipei Area. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 897:165392. [PMID: 37423284 DOI: 10.1016/j.scitotenv.2023.165392] [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: 02/13/2023] [Revised: 06/11/2023] [Accepted: 07/06/2023] [Indexed: 07/11/2023]
Abstract
Indoor air quality and home environmental characteristics are potential factors associated with the onset and exacerbation of allergic diseases. Our study examined the effects of these factors on allergic diseases (i.e., asthma, allergic rhinitis, allergic conjunctivitis, and atopic dermatitis) among preschool children. We recruited a total of 120 preschool children from an ongoing birth cohort study in the Greater Taipei Area. A comprehensive environmental evaluation was conducted at each participant's residence and included measurements of indoor and outdoor air pollutants, fungal spores, endotoxins, and house dust mite allergens. A structured questionnaire was used to collect information on the allergic diseases and home environments of participants. Land-use characteristics and points of interest in the surrounding area of each home were analyzed. Other covariates were obtained from the cohort data. Multiple logistic regressions were used to examine the relationships between allergic diseases and covariates. We observed that all mean indoor air pollutant levels were below Taiwan's indoor air quality standards. After adjustment for covariates, the total number of fungal spores and the ozone, Der f 1, and endotoxin levels were significantly associated with increased risks of allergic diseases. Biological contaminants more significantly affected allergic diseases than other pollutants. Moreover, home environmental characteristics (e.g., living near power facilities and gas stations) were associated with an increased risk of allergic diseases. Regular and proper home sanitation is recommended to prevent the accumulation of indoor pollutants, especially biological contaminants. Living away from potential sources of pollution is also crucial for protecting the health of children.
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Affiliation(s)
- Hsiao-Chun Huang
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Ming-Lun Zou
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Yi-Hua Chen
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan; Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan
| | - Chuen-Bin Jiang
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Chih-Da Wu
- Department of Geomatics, National Cheng Kung University, Tainan, Taiwan; National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan; Innovation and Development Center of Sustainable Agriculture, National Chung Hsing University, Tainan, Taiwan
| | | | - Ling-Chu Chien
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan; Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan
| | - Yu-Chun Lo
- Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan; Program in Medical Neuroscience, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Hsing Jasmine Chao
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan; Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan.
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Korvink M, Gunn LH, Molina G, Hackner D, Martin J. A Novel Approach to Developing Disease and Outcome-Specific Social Risk Indices. Am J Prev Med 2023; 65:727-734. [PMID: 37149108 PMCID: PMC10156642 DOI: 10.1016/j.amepre.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 05/08/2023]
Abstract
INTRODUCTION A variety of industry composite indices are employed within health research in risk-adjusted outcome measures and to assess health-related social needs. During the COVID-19 pandemic, the relationships among risk adjustment, clinical outcomes, and composite indices of social risk have become relevant topics for research and healthcare operations. Despite the widespread use of these indices, composite indices are often comprised of correlated variables and therefore may be affected by information duplicity of their underlying risk factors. METHODS A novel approach is proposed to assign outcome- and disease group-driven weights to social risk variables to form disease and outcome-specific social risk indices and apply the approach to the county-level Centers for Disease Control and Prevention social vulnerability factors for demonstration. The method uses a subset of principal components reweighed through Poisson rate regressions while controlling for county-level patient mix. The analyses use 6,135,302 unique patient encounters from 2021 across seven disease strata. RESULTS The reweighed index shows reduced root mean squared error in explaining county-level mortality in five of the seven disease strata and equivalent performance in the remaining strata compared with the reduced root mean squared error using the current Centers for Disease Control and Prevention Social Vulnerability Index as a benchmark. CONCLUSIONS A robust method is provided, designed to overcome challenges with current social risk indices, by accounting for redundancy and assigning more meaningful disease and outcome-specific variable weights.
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Affiliation(s)
| | - Laura H Gunn
- Department of Public Health Sciences, College of Health and Human Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina; The School of Data Science, University of North Carolina at Charlotte, Charlotte, North Carolina; Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom
| | | | - Dani Hackner
- Medicine Care Center, Southcoast Hospitals Group, New Bedford, Massachusetts
| | - John Martin
- ITS Data Science, Premier, Inc., Charlotte, North Carolina
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Moore CM, Thornburg J, Secor EA, Hamlington KL, Schiltz AM, Freeman KL, Everman JL, Fingerlin TE, Liu AH, Seibold MA. Breathing zone pollutant levels are associated with asthma exacerbations in high-risk children. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.22.23295971. [PMID: 37790375 PMCID: PMC10543064 DOI: 10.1101/2023.09.22.23295971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Background Indoor and outdoor air pollution levels are associated with poor asthma outcomes in children. However, few studies have evaluated whether breathing zone pollutant levels associate with asthma outcomes. Objective Determine breathing zone exposure levels of NO 2 , O 3 , total PM 10 and PM 10 constituents among children with exacerbation-prone asthma, and examine correspondence with in-home and community measurements and associations with outcomes. Methods We assessed children's personal breathing zone exposures using wearable monitors. Personal exposures were compared to in-home and community measurements and tested for association with lung function, asthma control, and asthma exacerbations. Results 81 children completed 219 monitoring sessions. Correlations between personal and community levels of PM 10 , NO 2 , and O 3 were poor, whereas personal PM 10 and NO 2 levels correlated with in-home measurements. However, in-home monitoring underdetected brown carbon (Personal:79%, Home:36.8%) and ETS (Personal:83.7%, Home:4.1%) personal exposures, and detected black carbon in participants without these personal exposures (Personal: 26.5%, Home: 96%). Personal exposures were not associated with lung function or asthma control. Children experiencing an asthma exacerbation within 60 days of personal exposure monitoring had 1.98, 2.21 and 2.04 times higher brown carbon (p<0.001), ETS (p=0.007), and endotoxin (p=0.012), respectively. These outcomes were not associated with community or in-home exposure levels. Conclusions Monitoring pollutant levels in the breathing zone is essential to understand how exposures influence asthma outcomes, as agreement between personal and in-home monitors is limited. Inhaled exposure to PM 10 constituents modifies asthma exacerbation risk, suggesting efforts to limit these exposures among high-risk children may decrease their asthma burden. CLINICAL IMPLICATIONS In-home and community monitoring of environmental pollutants may underestimate personal exposures. Levels of inhaled exposure to PM 10 constituents appear to strongly influence asthma exacerbation risk. Therefore, efforts should be made to mitigate these exposures. CAPSULE SUMMARY Leveraging wearable, breathing-zone monitors, we show exposures to inhaled pollutants are poorly proxied by in-home and community monitors, among children with exacerbation-prone asthma. Inhaled exposure to multiple PM 10 constituents is associated with asthma exacerbation risk.
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11
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Tayal A, Kabra SK. Indoor Air Pollution- Not the Lesser Evil! Indian J Pediatr 2023; 90:849-850. [PMID: 37430150 DOI: 10.1007/s12098-023-04763-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/12/2023]
Affiliation(s)
- Anshula Tayal
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - S K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Sharma R, Humphrey JL, Frueh L, Kinnee EJ, Sheffield PE, Clougherty JE. Neighborhood violence and socioeconomic deprivation influence associations between acute air pollution and temperature on childhood asthma in New York city. ENVIRONMENTAL RESEARCH 2023; 231:116235. [PMID: 37244495 PMCID: PMC10364588 DOI: 10.1016/j.envres.2023.116235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 05/29/2023]
Abstract
Ambient air pollution, temperature, and social stressor exposures are linked with asthma risk, with potential synergistic effects. We examined associations for acute pollution and temperature exposures, with modification by neighborhood violent crime and socioeconomic deprivation, on asthma morbidity among children aged 5-17 years year-round in New York City. Using conditional logistic regression in a time-stratified, case-crossover design, we quantified percent excess risk of asthma event per 10-unit increase in daily, residence-specific exposures to PM2.5, NO2, SO2, O3, and minimum daily temperature (Tmin). Data on 145,834 asthma cases presenting to NYC emergency departments from 2005 to 2011 were obtained from the New York Statewide Planning and Research Cooperative System (SPARCS). Residence- and day-specific spatiotemporal exposures were assigned using the NYC Community Air Survey (NYCCAS) spatial data and daily EPA pollution and NOAA weather data. Point-level NYPD violent crime data for 2009 (study midpoint) was aggregated, and Socioeconomic Deprivation Index (SDI) scores assigned, by census tract. Separate models were fit for each pollutant or temperature exposure for lag days 0-6, controlling for co-exposures and humidity, and mutually-adjusted interactions (modification) by quintile of violent crime and SDI were assessed. We observed stronger main effects for PM2.5 and SO2 in the cold season on lag day 1 [4.90% (95% CI: 3.77-6.04) and 8.57% (5.99-11.21), respectively]; Tmin in the cold season on lag day 0 [2.26% (1.25-3.28)]; and NO2 and O3 in the warm season on lag days 1 [7.86% (6.66-9.07)] and 2 [4.75% (3.53-5.97)], respectively. Violence and SDI modified the main effects in a non-linear manner; contrary to hypotheses, we found stronger associations in lower-violence and -deprivation quintiles. At very high stressor exposures, although asthma exacerbations were highly prevalent, pollution effects were less apparent-suggesting potential saturation effects in socio-environmental synergism.
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Affiliation(s)
- Rachit Sharma
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
| | - Jamie L Humphrey
- Center for Health Analytics, Media & Policy, RTI International, Research Triangle Park, NC, USA
| | - Lisa Frueh
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Ellen J Kinnee
- University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Perry E Sheffield
- Department of Environmental Medicine and Public Health, and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jane E Clougherty
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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El Homsi M, Sclison S, Huguet D, Dessimond B, Tanno LK, Prud'homme J, Collette A, Annesi-Maesano I. Association between air pollution levels and drug sales for asthma and allergy in 63 million people in metropolitan France. J Asthma 2023; 60:1246-1254. [PMID: 36332169 DOI: 10.1080/02770903.2022.2144348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 08/01/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Air pollution is known to have an impact on respiratory health. However, the assessment of this relationship is far from complete and is rarely extended to the country level. We used drug sales data, both Over-The-Counter (OTC) and prescription drugs, to assess exhaustively the impact of air pollution on asthma and allergy at the national level in France. METHODS The WHO Anatomical Therapeutic Chemical (ATC) classification system was used to describe the distribution of sales of drugs of class R03 (Drugs for obstructive airways diseases, overall for asthma) and R06 (Antihistamines for systemic use). We performed a Quasi-Poisson regression model with a generalized additive model (GAM) to estimate the relationship (Relative Risks and 95% Confidence Interval) between drug sales and air pollutants, that is Particulate Matter with a diameter less than 2.5 micrometers (PM2.5) and less than 10 micrometers (PM10) and Nitrogen dioxide (NO2), as assessed using the high-resolution CHIMERE dispersion model. We designed unadjusted and adjusted single-pollutant models as well as two-pollutant models. RESULTS PM2.5, PM10, and NO2 were significantly and positively associated with sales of R03 and R06 class drugs, after adjustment for potential confounders. Results were confirmed in the two-pollutant model for PM10 and NO2 but not for PM2.5. CONCLUSIONS Our study confirms the presence of an association between major air pollutants and the sales of drugs against asthma and allergies. Further studies on larger databases and over several years are necessary to confirm and better understand these results.
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Affiliation(s)
- Marwan El Homsi
- Desbrest Institute of Epidemiology and Public Health, Univ Montpellier, INSERM, Montpellier, France
| | | | | | - Boris Dessimond
- Desbrest Institute of Epidemiology and Public Health, Univ Montpellier, INSERM, Montpellier, France
| | - Luciana Kase Tanno
- Desbrest Institute of Epidemiology and Public Health, Univ Montpellier, INSERM, Montpellier, France
| | - Julie Prud'homme
- Desbrest Institute of Epidemiology and Public Health, Univ Montpellier, INSERM, Montpellier, France
| | - Augustin Collette
- Institut National de l'Environnement Industriel et des Risques (INERIS), Verneuil-en-Halatte, France
| | - Isabella Annesi-Maesano
- Desbrest Institute of Epidemiology and Public Health, Univ Montpellier, INSERM, Montpellier, France
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14
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Zhao X, Xu H, Li Y, Liu Y, Guo C, Li Y. Status and frontier analysis of indoor PM 2.5-related health effects: a bibliometric analysis. REVIEWS ON ENVIRONMENTAL HEALTH 2023; 0:reveh-2022-0228. [PMID: 36976918 DOI: 10.1515/reveh-2022-0228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
Epidemiological data indicate atmospheric particulate matter, especially fine particulate matter (PM2.5), has many negative effects on human health. Of note, people spend about 90% of their time indoors. More importantly, according to the World Health Organization (WHO) statistics, indoor air pollution causes nearly 1.6 million deaths each year, and it is considered as one of the major health risk factors. In order to obtain a deeper understanding of the harmful effects of indoor PM2.5 on human health, we used bibliometric software to summarize articles in this field. In conclusion, since 2000, the annual publication volume has increased year by year. America topped the list for the number of articles, and Professor Petros Koutrakis and Harvard University were the author and institution with the most published in this research area, respectively. Over the past decade, scholars gradually paid attention to molecular mechanisms, therefore, the toxicity can be better explored. Particularly, apart from timely intervention and treatment for adverse consequences, it is necessary to effectively reduce indoor PM2.5 through technologies. In addition, the trend and keywords analysis are favorable ways to find out future research hotspots. Hopefully, various countries and regions strengthen academic cooperation and integration of multi-disciplinary.
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Affiliation(s)
- Xinying Zhao
- Department of Toxicology and Sanitary Chemistry, School of Public Health, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, China
| | - Hailin Xu
- Department of Toxicology and Sanitary Chemistry, School of Public Health, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, China
| | - Yan Li
- Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, China
- Department of Occupational Health and Environmental Health, School of Public Health, Capital Medical University, Beijing, China
| | - Yufan Liu
- Department of Toxicology and Sanitary Chemistry, School of Public Health, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, China
| | - Caixia Guo
- Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, China
- Department of Occupational Health and Environmental Health, School of Public Health, Capital Medical University, Beijing, China
| | - Yanbo Li
- Department of Toxicology and Sanitary Chemistry, School of Public Health, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, China
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Fong WCG, Kadalayil L, Lowther S, Grevatt S, Potter S, Tidbury T, Bennett K, Larsson M, Nicolas F, Kurukulaaratchy R, Arshad SH. The efficacy of the Dyson air purifier on asthma control: A single-center, investigator-led, randomized, double-blind, placebo-controlled trial. Ann Allergy Asthma Immunol 2023; 130:199-205.e2. [PMID: 36288782 DOI: 10.1016/j.anai.2022.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/02/2022] [Accepted: 10/18/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Air pollution is associated with poor asthma outcomes. High-efficiency particulate air air purifiers may reduce air pollution and thus improve asthma outcomes. However, the efficacy of such devices for this purpose remains inconclusive. OBJECTIVE To investigate the effects of reducing the levels of pollutants on asthma outcomes in adults, using a novel Dyson high-efficiency particulate air air purifier. METHODS In a single-center, double-blinded, randomized controlled trial, participants (N = 50) were randomized at a 1:1 ratio to active filters (intervention) or to dummy filters (placebo) for a total of 78 weeks. The primary outcomes were the changes in Asthma Control Questionnaire 6 (ACQ6) and Asthma-specific Quality of Life Questionnaire (AQLQ) scores from baseline. The secondary outcomes were changes in indoor air pollution and lung function measurements. The coronavirus disease 2019 pandemic limited spirometry measurements to 2 time points and assessment of fractional exhaled nitric oxide and bronchial hyperresponsiveness to baseline only. RESULTS Air pollutant levels were significantly lower in the intervention group compared with the placebo group (P = .0003). Both groups had a significant improvement in their ACQ6 and AQLQ. However, there were no significant between-group differences in ACQ6, AQLQ, or spirometry, compared with baseline in multivariable repeated measures models. CONCLUSION The Dyson air purifier significantly improved air quality. However, there were no significant improvements in asthma control, quality of life, or measures of lung function in the intervention group compared with the control group despite improvements in indoor air quality. Larger, extended studies are required to confirm or refute these findings, especially given that the coronavirus disease 2019 pandemic prevented the procurement of detailed objective data. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04729530; ttps://clinicaltrials.gov/ct2/show/NCT04729530.
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Affiliation(s)
- Wei Chern Gavin Fong
- David Hide Asthma and Allergy Research Centre, Isle of Wight, United Kingdom; Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Latha Kadalayil
- David Hide Asthma and Allergy Research Centre, Isle of Wight, United Kingdom; Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Scott Lowther
- Dyson Technology Limited, Malmesbury, Wiltshire, United Kingdom
| | - Susan Grevatt
- David Hide Asthma and Allergy Research Centre, Isle of Wight, United Kingdom
| | - Stephen Potter
- David Hide Asthma and Allergy Research Centre, Isle of Wight, United Kingdom
| | - Tracey Tidbury
- David Hide Asthma and Allergy Research Centre, Isle of Wight, United Kingdom
| | - Kaisha Bennett
- David Hide Asthma and Allergy Research Centre, Isle of Wight, United Kingdom
| | - Maria Larsson
- David Hide Asthma and Allergy Research Centre, Isle of Wight, United Kingdom
| | | | - Ramesh Kurukulaaratchy
- David Hide Asthma and Allergy Research Centre, Isle of Wight, United Kingdom; Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; National Institute for Health Research Southampton Biomedical Research Centre, Southampton General Hospital, Southampton, United Kingdom
| | - Syed Hasan Arshad
- David Hide Asthma and Allergy Research Centre, Isle of Wight, United Kingdom; Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; National Institute for Health Research Southampton Biomedical Research Centre, Southampton General Hospital, Southampton, United Kingdom.
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Pappalardo AA, Martin MA, Weinstein S, Pugach O, Mosnaim GS. Improving Adherence in Urban Youth With Asthma: Role of Community Health Workers. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:3186-3193. [PMID: 36058514 PMCID: PMC10091238 DOI: 10.1016/j.jaip.2022.08.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The Asthma Action at Erie Trial is a comparative effectiveness trial comparing a community health worker (CHW) versus certified asthma educator (AE-C) intervention in low-income minority children. OBJECTIVES Determine whether asthma medication possession, adherence, technique, and triggers differ in children receiving an asthma CHW compared with an AE-C intervention. METHODS Children with uncontrolled asthma were randomized to receive 10 CHW home visits or 2 AE-C sessions in a clinic over 1 year. Asthma medication possession and inhaler technique were observed; adherence was measured using self-report, dose counters, and electronic monitors. Environmental triggers were captured by self-report, observation, and objective measurement. Mixed effects linear and logistic regression models were estimated for continuous and binary outcomes. RESULTS Children (n = 223) were mainly Hispanic (85%) and ages 5 to 16 years. Quick-relievers (82%), spacers (72%), and inhaled corticosteroid (ICS)-containing medications (44%) were tracked. Of those with uncontrolled asthma, 35% lacked an ICS prescription (n = 201). Children in the CHW arm were more likely to have an ICS prescription at 12 months (odds ratio 2.39; 95% CI 0.99-5.79). Inhaler technique improved 9.8% in the CHW arm at 6 months (95% CI 4.20-15.32). The ICS adherence improved in the CHW arm at 12 months, with a 16.0% (95% CI 2.3-29.7; P = .02) difference between arms. Differences in trigger exposure over time were not observed between arms. CONCLUSIONS The CHW services were associated with improved ICS adherence and inhaler technique, compared with AE-C services. More information is needed to determine the necessary dosage of intervention to sustain adherence.
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Affiliation(s)
- Andrea A Pappalardo
- Department of Medicine and Pediatrics, University of Illinois at Chicago of Medicine, Chicago, Ill.
| | - Molly A Martin
- Department of Pediatrics, University of Illinois at Chicago College of Medicine, Chicago, Ill
| | - Sally Weinstein
- Department of Psychiatry, University of Illinois at Chicago College of Medicine, Chicago, Ill
| | - Oksana Pugach
- Department of Biostatistics, Corevitas, LLC, Waltham, Mass
| | - Giselle S Mosnaim
- Division of Allergy and Immunology, Department of Medicine, NorthShore University Health System, Evanston, Ill
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Correa-Agudelo E, Ding L, Beck AF, Brokamp C, Altaye M, Kahn RS, Mersha TB. Understanding racial disparities in childhood asthma using individual- and neighborhood-level risk factors. J Allergy Clin Immunol 2022; 150:1427-1436.e5. [PMID: 35970309 PMCID: PMC9887733 DOI: 10.1016/j.jaci.2022.07.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 06/16/2022] [Accepted: 07/11/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Racial disparities in childhood asthma outcomes result from a complex interplay of individual- and neighborhood-level factors. OBJECTIVES We sought to examine racial disparities in asthma-related emergency department (ED) visits between African American (AA) and European American (EA) children. METHODS This is a retrospective study of patients younger than 18 years who visited the ED at Cincinnati Children's for asthma from 2009 to 2018. The outcome was number of ED visits during a year. We assessed 11 social, economic, and environmental variables. Mediation and mixed-effects analyses were used to assess relationships between race, mediators, and number of ED visits. RESULTS A total of 31,114 children (46.1% AA, 53.9% EA) had 186,779 asthma-related ED visits. AA children had more visits per year than EA children (2.23 vs 2.15; P < .001). Medicaid insurance was associated with a 7% increase in rate of ED visits compared with commercial insurance (1.07; 95% CI, 1.03-1.1). Neighborhood socioeconomic deprivation was associated with an increased rate of ED visits in AA but not in EA children. Area-level particulate matter with diameter less than 2.5 μm, pollen, and outdoor mold were associated with an increased rate of ED visits for both AA and EA children (all P < .001). Associations between race and number of ED visits were mediated by insurance, area-level deprivation, particulate matter with diameter less than 2.5 μm, and outdoor mold (all P < .001), altogether accounting for 55% of the effect of race on ED visits. Race was not associated with number of ED visits (P = .796) after accounting for mediators. CONCLUSIONS Racial disparities in asthma-related ED visits are mediated by social, economic, and environmental factors, which may be amenable to interventions aimed at improving outcomes and eliminating inequities.
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Affiliation(s)
- Esteban Correa-Agudelo
- Divisions of Asthma Research, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
| | - Lili Ding
- Divisions of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
| | - Andrew F Beck
- Divisions of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio; Divisions of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
| | - Cole Brokamp
- Divisions of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
| | - Mekibib Altaye
- Divisions of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
| | - Robert S Kahn
- Divisions of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
| | - Tesfaye B Mersha
- Divisions of Asthma Research, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio.
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Cushing AM, Khan MA, Kysh L, Brakefield WS, Ammar N, Liberman DB, Wilson J, Shaban-Nejad A, Espinoza J. Geospatial data in pediatric asthma in the United States: a scoping review protocol. JBI Evid Synth 2022; 20:2790-2798. [PMID: 36081367 PMCID: PMC9669090 DOI: 10.11124/jbies-21-00284] [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: 02/04/2023]
Abstract
OBJECTIVE The objective of this scoping review is to identify and describe the literature on the use of geospatial data in pediatric asthma research. INTRODUCTION Asthma is one of the most common pediatric chronic diseases in the United States, disproportionately affecting low-income patients. Asthma exacerbations may be triggered by local environmental factors, such as air pollution or exposure to indoor allergens. Geographic information systems are increasingly recognized as tools that use geospatial data to enhance understanding of the link between environmental exposure, social determinants of health, and clinical outcomes. Geospatial data in pediatric asthma may help inform risk factors for asthma severity, and guide targeted clinical and social interventions. INCLUSION CRITERIA This review will consider studies that utilize geospatial data in the evaluation of pediatric patients with asthma, ages 2 to 18 years, in the United States. Mixed samples of adults and children will also be considered. Geospatial data will include any external non-clinical geographic-based data source that uses a patient's environment or context. METHODS The following databases will be searched: PubMed, Embase, Cochrane CENTRAL, CINAHL, ERIC, Web of Science, and IEEE. Gray literature will be searched in DBLP, the US Environmental Protection Agency, Google Scholar, Google search, and a hand search of recent abstracts from relevant conferences. Articles published in English, Spanish, and French from 2010 to the present will be included. Study screening and selection will be performed independently by 2 reviewers. Data extraction will be performed by a trained research team member following pilot testing.
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Affiliation(s)
- Anna M. Cushing
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Masrur A. Khan
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Lynn Kysh
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Whitney S. Brakefield
- Bredesen Center for Data Science and Engineering, University of Tennessee, Knoxville, TN, United States
- Oak Ridge National Laboratory Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Nariman Ammar
- Oak Ridge National Laboratory Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Danica B. Liberman
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - John Wilson
- Spatial Sciences Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA, United States
| | - Arash Shaban-Nejad
- Oak Ridge National Laboratory Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Juan Espinoza
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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20
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Wong M, Forno E, Celedón JC. Asthma interactions between obesity and other risk factors. Ann Allergy Asthma Immunol 2022; 129:301-306. [PMID: 35500862 PMCID: PMC10825856 DOI: 10.1016/j.anai.2022.04.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/07/2022] [Accepted: 04/21/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To review and critically discuss published evidence on interactions between obesity and selected risk factors on asthma in children and adults, and to discuss potential future directions in this field. DATA SOURCES National Library of Medicine (via PubMed) STUDY SELECTION: A literature search was conducted for human studies on obesity and selected interactions (with sex, race and ethnicity, socioeconomic status, indoor and outdoor pollutants, depression, anxiety, and diet) on asthma. Studies that were published in English and contained a full text were considered for inclusion in this review. RESULTS Current evidence supports interactions between obesity and outdoor and indoor air pollutants (including second-hand smoke [SHS]) on enhancing asthma risk, although there are sparse data on the specific pollutants underlying such interactions. Limited evidence also suggests that obesity may modify the effects of depression or anxiety on asthma, whereas little is known about potential interactions between obesity and sex-hormone levels or dietary patterns. CONCLUSION Well-designed observational prospective studies (eg, for pollutants and sex hormones) and randomized clinical trials (eg, for the treatment of depression) should help establish the impact of modifying coexisting exposures to reduce the harmful effects of obesity on asthma. Such studies should be designed to have a sample size that is large enough to allow adequate testing of interactions between obesity and risk factors that are identified a priori and thus, well characterized, using objective measures and biomarkers (eg, urinary or serum cotinine for SHS, epigenetic marks of specific environmental exposures).
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Affiliation(s)
- Matthew Wong
- Division of Pulmonary Medicine, Department of Pediatrics, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Erick Forno
- Division of Pulmonary Medicine, Department of Pediatrics, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Juan C Celedón
- Division of Pulmonary Medicine, Department of Pediatrics, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
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21
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Ranasinghe JC, Karunarathne RR, Munasinghe TS, Vidanapathirana GU, Kudagammna ST. Childhood allergic diseases across geographical regions of Kandy and Anuradhapura districts of Sri Lanka; where do the rates stand among other regions: experience from Global asthma network Phase 1 study. Allergy Asthma Clin Immunol 2022; 18:79. [PMID: 36031628 PMCID: PMC9420266 DOI: 10.1186/s13223-022-00720-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 08/12/2022] [Indexed: 11/30/2022] Open
Abstract
Background Asthma, allergic rhinitis and eczema have been identified as the most prevalent childhood allergic diseases. However, the prevalence of these allergic diseases can vary in different regions within a country and in the world. Methods The objective of the study was to estimate the prevalence of asthma, allergic rhinitis and eczema in schoolchildren in the Kandy and Anuradhapura districts of Sri Lanka. This was a multicentre cross sectional study carried out among children of age 6–7 years and 13–14 years attending state schools fulfilling the entry criteria of the Global Asthma Network Phase 1 study methodology. Results A total of 3673 children of 6–7 years and 4658 children of 13–14 years were recruited. The prevalence of current asthma, allergic rhinitis and eczema were 12% (CI 10.44–13.75), 15.7% (CI 13.94–17.64) and 9.7% (CI 8.30–11.31) among 6–7 years age group and 15.3% (CI 13.66–17.09), 30.5% (CI 28.86–32.74) and 7.3% (CI 6.15–8.65) respectively among the 13–14 age group in Kandy district. The reported prevalence rates of the disease conditions were 9.9% (CI 8.72–11.22), 10.1% (CI 8.90–11.44) and 5.9% (CI 4.98–6.98) among 6–7 years age group and 14.9% (CI 13.67–16.22), 22.5% (CI 21.04–24.03) and 1.8% (CI 1.38–2.34) in the 13–14 years age group in Anuradhapura district. When comparing these prevalence rates, there is relatively a higher prevalence of childhood allergic diseases in Kandy district. This difference is statistically significant in all three allergic disease conditions (P < 0.001). Conclusion Prevalence of allergic diseases in Anuradhapura is closer to reported data in the previous studies. There is relatively higher prevalence of childhood allergic diseases among children in Kandy district.
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Landrigan PJ, Fisher S, Kenny ME, Gedeon B, Bryan L, Mu J, Bellinger D. A replicable strategy for mapping air pollution's community-level health impacts and catalyzing prevention. Environ Health 2022; 21:70. [PMID: 35843932 PMCID: PMC9288863 DOI: 10.1186/s12940-022-00879-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Air pollution was responsible for an estimated 6.7 million deaths globally in 2019 and 197,000 deaths in the United States. Fossil fuel combustion is the major source. HYPOTHESIS Mapping air pollution's health impacts at the community level using publicly available data and open-source software will provide a replicable strategy for catalyzing pollution prevention. METHODS Using EPA's Environmental Benefits Mapping and Analysis (BenMAP-CE) software and state data, we quantified the effects of airborne fine particulate matter (PM2.5) pollution on disease, death and children's cognitive function (IQ Loss) in each city and town in Massachusetts. To develop a first-order estimate of PM2.5 pollution's impact on child IQ, we derived a concentration-response coefficient through literature review. FINDINGS The annual mean PM2.5 concentration in Massachusetts in 2019 was 6.3 μg/M3, a level below EPA's standard of 12 μg/M3 and above WHO's guideline of 5 μg/M3. In adults, PM2.5 pollution was responsible for an estimated 2780 (Confidence Interval [CI] 2726 - 2853) deaths: 1677 (CI, 1346 - 1926) from cardiovascular disease, 2185 (CI, 941-3409) from lung cancer, 200 (CI, 66-316) from stroke, and 343 (CI, 222-458) from chronic respiratory disease. In children, PM2.5 pollution was responsible for 308 (CI, 105-471) low-weight births, 15,386 (CJ, 5433-23,483) asthma cases, and a provisionally estimated loss of nearly 2 million Performance IQ points; IQ loss impairs children's school performance, reduces graduation rates and decreases lifetime earnings. Air-pollution-related disease, death and IQ loss were most severe in low-income, minority communities, but occurred in every city and town in Massachusetts regardless of location, demographics or median family income. CONCLUSION Disease, death and IQ loss occur at air pollution exposure levels below current EPA standards. Prevention of disease and premature death and preservation of children's cognitive function will require that EPA air quality standards be tightened. Enduring prevention will require government-incentivized transition to renewable energy coupled with phase-outs of subsidies and tax breaks for fossil fuels. Highly localized information on air pollution's impacts on health and on children's cognitive function has potential to catalyze pollution prevention.
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Affiliation(s)
- Philip J Landrigan
- Global Observatory on Pollution and Health, Boston College, Boston, MA, USA.
- Centre Scientifique de Monaco, Monaco, MC, Monaco.
| | - Samantha Fisher
- Global Observatory on Pollution and Health, Boston College, Boston, MA, USA
- Environmental; Epidemiology Program, City University of New York, New York, USA
| | - Maureen E Kenny
- Lynch School of Education and Human Development, Boston College, Boston, MA, USA
| | - Brittney Gedeon
- Morrissey College of Arts and Sciences, Boston College, Boston, MA, USA
| | - Luke Bryan
- Morrissey College of Arts and Sciences, Boston College, Boston, MA, USA
| | - Jenna Mu
- Morrissey College of Arts and Sciences, Boston College, Boston, MA, USA
| | - David Bellinger
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, USA
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Contrast Media Adverse Drug Reactions in Highly Polluted Environment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127077. [PMID: 35742323 PMCID: PMC9223239 DOI: 10.3390/ijerph19127077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 01/27/2023]
Abstract
Iodinated- (ICM) and gadolinium-based (GCM) contrast media are used in radiology imaging techniques, such as computer tomography (CT) and magnetic resonance (MR), respectively. The paper aims to analyze the adverse drug reactions of ICM and GCM on different sites of the body in a highly polluted environment. We analyzed the pharmacovigilance in contrast media on the basis of reports submitted to the Regional Center for Monitoring of Adverse Drug Reactions (ADR) at the Department of Clinical Pharmacology in Wrocław. Safety profiles were compared between different ICM and GCM and at the system organ level using the proportional reporting ratio (PRR). We analyzed 124 reports of adverse reactions related to contrast agents between 2006 and 2021. Our findings revealed that ADR combinations occurred more frequently after the use of iodinated contrast agents (72.08%) than gadolinium contrast agents (27.92%). Iomeprol and Iopromide were identified as the most frequently reported media. Each medium presented a different safety profile. Skin disorders are the most common adverse drug reactions among patients using both iodine- and gadolinium-based contrast media. Gadolinium-based contrast agents are characterized by similar organ toxicity. Conversely, iodine-based contrast agents are more diverse—some of which show tissue specificity, such as Iodixanol for the gastrointestinal system or Iohexol for the respiratory tract. This study shows relatively high occurrence of respiratory tract related ADRs in Wrocław. We also prove that it is possible to choose the most optimal contrast agent for patients with specific organ site problems to omit the possible complications.
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Eghomwanre AF, Oguntoke O, Taiwo AM. Levels of indoor particulate matter and association with asthma in children in Benin City, Nigeria. ENVIRONMENTAL MONITORING AND ASSESSMENT 2022; 194:467. [PMID: 35648237 DOI: 10.1007/s10661-022-10135-3] [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: 02/01/2022] [Accepted: 05/23/2022] [Indexed: 06/15/2023]
Abstract
The relationship between indoor particulate matter and asthma in children was assessed in this study. Forty-five (45) locations were randomly selected across the five local government areas in Benin City, Edo State, for air quality assessment. Indoor and outdoor particulates (PM1.0, PM2.5, and PM10) were monitored monthly using a handheld BLATN particulate sampler (Br-Smart-126S series). Reported clinical cases of asthma in children from 2008 to 2017 were collected from two major hospitals in the metropolis. The data obtained were analysed with SPSS for Windows version 21.0. The average concentrations of indoor and ambient PM ranged between 10.7-26.2 and 19.0-49.4 µg/m3 (PM1.0), 27.4-59.6 and 45.6-93.0 µg/m3 (PM2.5), and 33.5-67.9 and 60.9-106.1 µg/m3 (PM10) in the wet and dry seasons. PM2.5 and PM10 concentrations were observed above the WHO standards. Indoor particulate concentration was significantly (p = 0.001-0.012) higher in the dry season across the locations. Outdoor PM correlated positively (R = 0.568-0.855, p < 0.05; R2 = 0.322-0.724, p < 0.001) with their corresponding indoor PM concentration. The hazard ratio (HR) values of PM2.5 and PM10 exceeded 1 in all the sampling locations during the dry season, while the mean total hazard ratio (THR) of both PM metrics was considerably higher during the dry season than in the wet season. Indoor PM concentrations showed a significant positive correlation with reported cases of asthma (R = 0.498-0.542, p < 0.001) and accounted for 40.6% of the asthma cases during the dry season. The study showed that children in the selected households are at risk of increased asthma exacerbation due to exposure to particulate matter pollution.
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Affiliation(s)
- A F Eghomwanre
- Department of Environmental Management and Toxicology, Faculty of Life Sciences, University of Benin, Benin City, Nigeria.
- Department of Environmental Management and Toxicology, College of Environmental Resources Management, Federal University of Agriculture, Abeokuta, Nigeria.
| | - O Oguntoke
- Department of Environmental Management and Toxicology, College of Environmental Resources Management, Federal University of Agriculture, Abeokuta, Nigeria
| | - A M Taiwo
- Department of Environmental Management and Toxicology, College of Environmental Resources Management, Federal University of Agriculture, Abeokuta, Nigeria
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Kim S, Stanton K, Park Y, Thomas S. A Mobile App for Children With Asthma to Monitor Indoor Air Quality (AirBuddy): Development and Usability Study. JMIR Form Res 2022; 6:e37118. [PMID: 35604753 PMCID: PMC9171598 DOI: 10.2196/37118] [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: 02/07/2022] [Revised: 03/21/2022] [Accepted: 03/31/2022] [Indexed: 11/30/2022] Open
Abstract
Background Indoor air quality is an important environmental factor that triggers and exacerbates asthma, the most common chronic disease in children. A mobile app to monitor indoor air quality could help occupants keep their indoor air quality clean. However, no app is available that allows children to monitor and improve their indoor air quality. Objective Previously, we conducted a series of user-centered design studies to identify user needs and design requirements toward creating a mobile app that helps children with asthma to engage in monitoring and improving indoor air quality as part of their asthma management. Based on the findings from these studies, we created AirBuddy, a child-friendly app that visualizes air quality indoors and outdoors. Methods This paper reports on the findings from a field deployment with 7 pediatric asthma patients, where we evaluated AirBuddy’s usability and usefulness in real-world settings by conducting weekly semistructured interviews for 8 weeks. Results All participants positively responded to the usefulness and usability of AirBuddy, which we believe is thanks to the iterative, user-centered design approach that allowed us to identify and address potential usability issues early on and throughout the design process. Conclusions This project contributes to the field of mHealth app design for children by demonstrating how a user-centered design process can lead to the development of digital devices that are more acceptable and relevant to target users’ needs.
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Affiliation(s)
- Sunyoung Kim
- Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Kaitlyn Stanton
- Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Yunoh Park
- Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Stephen Thomas
- Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
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Grant TL, Wood RA. The influence of urban exposures and residence on childhood asthma. Pediatr Allergy Immunol 2022; 33:e13784. [PMID: 35616896 PMCID: PMC9288815 DOI: 10.1111/pai.13784] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 12/19/2022]
Abstract
Children with asthma who live in urban neighborhoods experience a disproportionately high asthma burden, with increased incident asthma and increased asthma symptoms, exacerbations, and acute visits and hospitalizations for asthma. There are multiple urban exposures that contribute to pediatric asthma morbidity, including exposure to pest allergens, mold, endotoxin, and indoor and outdoor air pollution. Children living in urban neighborhoods also experience inequities in social determinants of health, such as increased poverty, substandard housing quality, increased rates of obesity, and increased chronic stress. These disparities then in turn can increase the risk of urban exposures and compound asthma morbidity as poor housing repair is a risk factor for pest infestation and mold exposure and poverty is a risk factor for exposure to air pollution. Environmental interventions to reduce in-home allergen concentrations have yielded inconsistent results. Population-level interventions including smoking bans in public places and legislation to decrease traffic-related air pollution have been successful at reducing asthma morbidity and improving lung function growth. Given the interface and synergy between urban exposures and social determinants of health, it is likely population and community-level changes will be needed to decrease the excess asthma burden in children living in urban neighborhoods.
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Affiliation(s)
- Torie L Grant
- Division of Pediatric Allergy, Immunology, and Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert A Wood
- Division of Pediatric Allergy, Immunology, and Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Kaviany P, Brigham EP, Collaco JM, Rice JL, Woo H, Wood M, Koehl R, Wu TD, Eakin MN, Koehler K, Hansel NN, McCormack MC. Patterns and predictors of air purifier adherence in children with asthma living in low-income, urban households. J Asthma 2022; 59:946-955. [PMID: 33625291 PMCID: PMC8429515 DOI: 10.1080/02770903.2021.1893745] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Black children and children from low-income communities are disproportionately affected by asthma, attributed partly to pollution exposure. Air purifiers reduce indoor air pollution and improve asthma symptoms in children. In order to implement air purifier interventions, an understanding of patterns of use and potential barriers is necessary. METHODS In a home intervention study, 127 children with asthma living in Baltimore were randomized to receive two active or two placebo air purifiers. The 16-week study period included: baseline clinic visit, home visit for air purifier installation (active or placebo) with instruction to use the high or turbo settings, and electronic adherence monitoring of air purifiers. Determinants of adherence were identified using linear regression models. RESULTS Air purifiers were used 80% of the time, and participants demonstrated adherence to high or turbo settings for 60% of the time. In an adjusted model, season was the major determinant of air purifier adherence, with 21% lower use in the winter (p = 0.025) attributed to the cold draft generated by the machine. CONCLUSION In a clinical trial with electronic adherence monitoring, air purifier use was high and participants were adherent to use of high or turbo settings the majority of the time. Addressing practical barriers to consistent use, such as draft during the winter, in addition to financial barriers may improve air purifier adherence among children with asthma living in low-income, urban households. CLINICAL TRIALS REGISTRY NUMBER NCT02763917.
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Affiliation(s)
- Parisa Kaviany
- Johns Hopkins University School of Medicine, Department of Pediatric Pulmonology
| | - Emily P. Brigham
- Johns Hopkins University School of Medicine, Department of Pulmonology and Critical Care
| | - Joseph M. Collaco
- Johns Hopkins University School of Medicine, Department of Pediatric Pulmonology
| | - Jessica L. Rice
- Johns Hopkins University School of Medicine, Department of Pediatric Pulmonology
| | - Han Woo
- Johns Hopkins University School of Medicine, Department of Pulmonology and Critical Care
| | - Megan Wood
- Johns Hopkins University Bloomberg School of Public Health, Department of Environmental and Health Engineering
| | - Rachelle Koehl
- Johns Hopkins University School of Medicine, Department of Pulmonology and Critical Care
| | - Tianshi David Wu
- Johns Hopkins University School of Medicine, Department of Pulmonology and Critical Care
| | - Michelle N. Eakin
- Johns Hopkins University School of Medicine, Department of Pulmonology and Critical Care
| | - Kirsten Koehler
- Johns Hopkins University Bloomberg School of Public Health, Department of Environmental and Health Engineering
| | - Nadia N. Hansel
- Johns Hopkins University School of Medicine, Department of Pulmonology and Critical Care
| | - Meredith C. McCormack
- Johns Hopkins University School of Medicine, Department of Pulmonology and Critical Care
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Hurbain P, Liu Y, Strickland MJ, Li D. A cross-sectional analysis of associations between environmental indices and asthma in U.S. counties from 2003 to 2012. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2022; 32:320-332. [PMID: 33895778 PMCID: PMC8542056 DOI: 10.1038/s41370-021-00326-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 03/20/2021] [Accepted: 03/30/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND To capture the impacts of environmental stressors, environmental indices like the Air Quality Index, Toxic Release Inventory, and Environmental Quality Index have been used to investigate the environmental quality and its association with public health issues. However, past studies often rely on relatively small sample sizes, and they have typically not adjusted for important individual-level disease risk factors. OBJECTIVE We aim to estimate associations between existing environmental indices and asthma prevalence over a large population and multiple years. METHODS Based on data availability, we assessed the predictive capability of these indices for prevalent asthma across U.S. counties from 2003 to 2012. We gathered asthma data from the U.S. CDC Behavioral Risk Factor Surveillance System by county and used multivariable weighted logistic regression models to estimate the associations between the environmental indices and asthma, adjusting for individual factors such as smoking, income level, and obesity. RESULTS Environmental indices showed little to no correlation with one another and with prevalent asthma over time. Associations of environmental indices with prevalent asthma were very weak; whereas individual factors were more substantially associated with prevalent asthma. SIGNIFICANCE Our study suggests that an improved environmental index is needed to predict population-level asthma prevalence.
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Affiliation(s)
- Patrick Hurbain
- School of Community Health Sciences, University of Nevada, Reno, NV, USA
| | - Yan Liu
- School of Community Health Sciences, University of Nevada, Reno, NV, USA
| | | | - Dingsheng Li
- School of Community Health Sciences, University of Nevada, Reno, NV, USA.
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Kaviany P, Senter JP, Collaco JM, Corrigan AE, Brigham E, Wood M, Woo H, Liu C, Koehl R, Galiatsatos P, Koehler K, Hansel N, McCormack M. Spatial analysis of tobacco outlet density on secondhand smoke exposure and asthma health among children in Baltimore City. Tob Control 2022; 32:tobaccocontrol-2021-056878. [PMID: 35046128 PMCID: PMC9294062 DOI: 10.1136/tobaccocontrol-2021-056878] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/27/2021] [Indexed: 11/03/2022]
Abstract
RATIONALE Tobacco outlets are concentrated in low-income neighbourhoods; higher tobacco outlet density is associated with increased smoking prevalence. Secondhand smoke (SHS) exposure has significant detrimental effects on childhood asthma. We hypothesised there was an association between higher tobacco outlet density, indoor air pollution and worse childhood asthma. METHODS Baseline data from a home intervention study of 139 children (8-17 years) with asthma in Baltimore City included residential air nicotine monitoring, paired with serum cotinine and asthma control assessment. Participant addresses and tobacco outlets were geocoded and mapped. Multivariable regression modelling was used to describe the relationships between tobacco outlet density, SHS exposure and asthma control. RESULTS Within a 500 m radius of each participant home, there were on average six tobacco outlets. Each additional tobacco outlet in a 500 m radius was associated with a 12% increase in air nicotine (p<0.01) and an 8% increase in serum cotinine (p=0.01). For every 10-fold increase in air nicotine levels, there was a 0.25-point increase in Asthma Therapy Assessment Questionnaire (ATAQ) score (p=0.01), and for every 10-fold increase in serum cotinine levels, there was a 0.54-point increase in ATAQ score (p<0.05). CONCLUSIONS Increased tobacco outlet density is associated with higher levels of bedroom air nicotine and serum cotinine. Increasing levels of SHS exposure (air nicotine and serum cotinine) are associated with less controlled childhood asthma. In Baltimore City, the health of children with asthma is adversely impacted in neighbourhoods where tobacco outlets are concentrated. The implications of our findings can inform community-level interventions to address these health disparities.
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Affiliation(s)
- Parisa Kaviany
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - James Paul Senter
- Pediatrics Residency Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Joseph Michael Collaco
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anne E Corrigan
- Spatial Science for Public Health Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Emily Brigham
- Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Megan Wood
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Han Woo
- Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Chen Liu
- Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Rachelle Koehl
- Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Panagis Galiatsatos
- Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kirsten Koehler
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nadia Hansel
- Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Meredith McCormack
- Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Khanna A, Banoth B, Verma A, Bhalla K, Holla S, Yadav S. Comparative effectiveness of oral dexamethasone vs. oral prednisolone for acute exacerbation of asthma: A randomized control trial. J Family Med Prim Care 2022; 11:1395-1400. [PMID: 35516722 PMCID: PMC9067196 DOI: 10.4103/jfmpc.jfmpc_1210_21] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 10/12/2021] [Accepted: 12/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Acute exacerbation of asthma is a common condition leading to emergency visits. Prednisolone is a commonly prescribed drug in the standard management of acute exacerbation of asthma along with other drugs. This study was planned to see the efficacy of oral dexamethasone when compared with oral prednisolone in the management of acute exacerbation of asthma. Methods: A single-center pilot study in the form of randomized control trial was done by recruiting children aged 2–14 years diagnosed with acute asthma exacerbation with mild to moderate severity. A total of 88 patients received oral dexamethasone (0.3 mg/kg) in two doses 24 h apart, which was compared with 87 patients who received oral prednisolone (1 mg/kg) in two divided doses 12 h apart for 5 days. The patients were assessed at the time of admission (zero hour), at 4th hour, and on the 5th day by various parameters such as respiratory rate, use of accessory muscles, Pediatric Respiratory Assessment Measure (PRAM) score, peak expiratory flow rate (PEFR), 6-h admission stay, and rate of hospital admission. Results: Baseline demographic profile, clinical characteristics, comorbidities, indoor pollution, and use of Metered Dose Inhaler (MDI) among the two study groups were comparable. Six-hour emergency stay and rate of admission were significantly lower in the dexamethasone group (P < 0.05). Improvement in PRAM score, PEFR, use of accessory muscles, and respiratory rate was also better in dexamethasone group at the 4th hour and 5th day (P < 0.05). In addition, oral dexamethasone was shown to have less incidence of vomiting/gastritis than prednisolone (P < 0.05). Conclusion: Oral dexamethasone can be considered a reliable and better option as compared with prednisolone due to its faster action and minimal side effects.
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İPEK Ö, İPEK E. Effects of indoor air pollution on household health: evidence from Turkey. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:67519-67527. [PMID: 34258706 PMCID: PMC8277228 DOI: 10.1007/s11356-021-15175-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/24/2021] [Indexed: 05/31/2023]
Abstract
Indoor air pollution caused by the use of biomass energy in heating and cooking adversely affects the health status of household members. In Turkey, with the rapid economic growth of the last decade, biomass has been among the most consumed types of household energy for heating and cooking due to inadequate infrastructure, dependence on foreign energy, and high energy prices. This study aims to add empirical evidence to the literature on health status and indoor air pollution in Turkey caused by households' energy choices. This study analyzed these effects with random effects panel discrete ordered models using the Income Living Conditions Micro Longitudinal Data Set for the period 2014-2017. As a result of the analysis, we found that the factors of age, being female, having dependent children, and indoor air pollution have adverse effects on health status. However, education level and income level affect health status positively. The most important observation obtained from this study is that even high-income households are adversely affected by indoor air pollution due to the lack of access to clean energy resources.
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Affiliation(s)
- Özlem İPEK
- Department of Management Information Systems, Tarsus University, 33400 Tarsus, Mersin Turkey
| | - Egemen İPEK
- Department of Finance & Banking, Tarsus University, 33400 Tarsus, Mersin Turkey
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Indoor Air Quality Prior to and Following School Building Renovation in a Mid-Atlantic School District. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212149. [PMID: 34831903 PMCID: PMC8624555 DOI: 10.3390/ijerph182212149] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/12/2021] [Accepted: 11/16/2021] [Indexed: 11/22/2022]
Abstract
Children spend the majority of their time indoors, and a substantial portion of this time in the school environment. Air pollution has been shown to adversely impact lung development and has effects that extend beyond respiratory health. The goal of this study was to evaluate the indoor environment in public schools in the context of an ongoing urban renovation program to investigate the impact of school building renovation and replacement on indoor air quality. Indoor air quality (CO2, PM2.5, CO, and temperature) was assessed for two weeks during fall, winter, and spring seasons in 29 urban public schools between December 2015 and March 2020. Seven schools had pre- and post-renovation data available. Linear mixed models were used to examine changes in air quality outcomes by renovation status in the seven schools with pre- and post-renovation data. Prior to renovation, indoor CO measurements were within World Health Organization (WHO) guidelines, and indoor PM2.5 measurements rarely exceeded them. Within the seven schools with pre- and post-renovation data, over 30% of indoor CO2 measurements and over 50% of indoor temperatures exceeded recommended guidelines from the American Society of Heating, Refrigerating, and Air Conditioning Engineers. Following renovation, 10% of indoor CO2 measurements and 28% of indoor temperatures fell outside of the recommended ranges. Linear mixed models showed significant improvement in CO2, indoor PM2.5, and CO following school renovation. Even among schools that generally met recommendations on key guidelines, school renovation improved the indoor air quality. Our findings suggest that school renovation may benefit communities of children, particularly those in low-income areas with aging school infrastructure, through improvements in the indoor environment.
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Laursen KR, Rasmussen BB, Rosati B, Gutzke VH, Østergaard K, Ravn P, Kjaergaard SK, Bilde M, Glasius M, Sigsgaard T. Acute health effects from exposure to indoor ultrafine particles-A randomized controlled crossover study among young mild asthmatics. INDOOR AIR 2021; 31:1993-2007. [PMID: 34235780 DOI: 10.1111/ina.12902] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/09/2021] [Accepted: 06/23/2021] [Indexed: 06/13/2023]
Abstract
Particulate matter is linked to adverse health effects, however, little is known about health effects of particles emitted from typical indoor sources. We examined acute health effects of short-term exposure to emissions from cooking and candles among asthmatics. In a randomized controlled double-blinded crossover study, 36 young non-smoking asthmatics attended three exposure sessions lasting 5 h: (a) air mixed with emissions from cooking (fine particle mass concentration): (PM2.5 : 96.1 μg/m3 ), (b) air mixed with emissions from candles (PM2.5 : 89.8 μg/m3 ), and c) clean filtered air (PM2.5 : 5.8 μg/m3 ). Health effects (spirometry, fractional exhaled Nitric Oxide [FeNO], nasal volume and self-reported symptoms) were evaluated before exposure start, then 5 and 24 h after. During exposures volatile organic compounds (VOCs), particle size distributions, number concentrations and optical properties were measured. Generally, no statistically significant changes were observed in spirometry, FeNO, or nasal volume comparing cooking and candle exposures to clean air. In males, nasal volume and FeNO decreased after exposure to cooking and candles, respectively. Participants reported additional and more pronounced symptoms during exposure to cooking and candles compared to clean air. The results indicate that emissions from cooking and candles exert mild inflammation in asthmatic males and decrease comfort among asthmatic males and females.
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Affiliation(s)
| | | | - Bernadette Rosati
- Department of Chemistry, Aarhus University, Aarhus, Denmark
- Faculty of Physics, University of Vienna, Vienna, Austria
| | - Vibeke Heitmann Gutzke
- Environment, Work and Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Kirsten Østergaard
- Environment, Work and Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Peter Ravn
- Environment, Work and Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Merete Bilde
- Department of Chemistry, Aarhus University, Aarhus, Denmark
| | | | - Torben Sigsgaard
- Environment, Work and Health, Department of Public Health, Aarhus University, Aarhus, Denmark
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Zhang L, Ou C, Magana-Arachchi D, Vithanage M, Vanka KS, Palanisami T, Masakorala K, Wijesekara H, Yan Y, Bolan N, Kirkham MB. Indoor Particulate Matter in Urban Households: Sources, Pathways, Characteristics, Health Effects, and Exposure Mitigation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11055. [PMID: 34769574 PMCID: PMC8582694 DOI: 10.3390/ijerph182111055] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 02/07/2023]
Abstract
Particulate matter (PM) is a complex mixture of solid particles and liquid droplets suspended in the air with varying size, shape, and chemical composition which intensifies significant concern due to severe health effects. Based on the well-established human health effects of outdoor PM, health-based standards for outdoor air have been promoted (e.g., the National Ambient Air Quality Standards formulated by the U.S.). Due to the exchange of indoor and outdoor air, the chemical composition of indoor particulate matter is related to the sources and components of outdoor PM. However, PM in the indoor environment has the potential to exceed outdoor PM levels. Indoor PM includes particles of outdoor origin that drift indoors and particles that originate from indoor activities, which include cooking, fireplaces, smoking, fuel combustion for heating, human activities, and burning incense. Indoor PM can be enriched with inorganic and organic contaminants, including toxic heavy metals and carcinogenic volatile organic compounds. As a potential health hazard, indoor exposure to PM has received increased attention in recent years because people spend most of their time indoors. In addition, as the quantity, quality, and scope of the research have expanded, it is necessary to conduct a systematic review of indoor PM. This review discusses the sources, pathways, characteristics, health effects, and exposure mitigation of indoor PM. Practical solutions and steps to reduce exposure to indoor PM are also discussed.
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Affiliation(s)
- Ling Zhang
- Nantong Key Laboratory of Intelligent and New Energy Materials, Nantong University, Nantong 226019, China;
- School of Health, Jiangsu Food & Pharmaceutical Science College, Huai’an 223003, China
| | - Changjin Ou
- Nantong Key Laboratory of Intelligent and New Energy Materials, Nantong University, Nantong 226019, China;
| | - Dhammika Magana-Arachchi
- Molecular Microbiology and Human Diseases Project, National Institute of Fundamental Studies, Hantana Road, Kandy 20000, Sri Lanka; (D.M.-A.); (M.V.)
| | - Meththika Vithanage
- Molecular Microbiology and Human Diseases Project, National Institute of Fundamental Studies, Hantana Road, Kandy 20000, Sri Lanka; (D.M.-A.); (M.V.)
- Ecosphere Resilience Research Center, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda 10250, Sri Lanka
| | - Kanth Swaroop Vanka
- Priority Research Centre for Healthy Lungs, Faculty of Health and Medicine, School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, NSW 2308, Australia;
| | - Thava Palanisami
- Global Innovative Centre for Advanced Nanomaterials (GICAN), Faculty of Engineering and Built Environment, The University of Newcastle, Callaghan, NSW 2308, Australia;
| | - Kanaji Masakorala
- Department of Botany, Faculty of Science, University of Ruhuna, Matara 80000, Sri Lanka;
| | - Hasintha Wijesekara
- Department of Natural Resources, Faculty of Applied Sciences, Sabaragamuwa University of Sri Lanka, Belihuloya 70140, Sri Lanka;
| | - Yubo Yan
- Jiangsu Engineering Laboratory for Environment Functional Materials, Huaiyin Normal University, Huai’an 223300, China
| | - Nanthi Bolan
- School of Agriculture and Environment, Institute of Agriculture, The University of Western Australia, Perth, WA 6001, Australia;
| | - M. B. Kirkham
- Department of Agronomy, Kansas State University, Manhattan, KS 66506, USA;
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Wang C, Wei CC, Wan L, Lin CL, Tsai JD. Association of exposure to hydrocarbon air pollution with the incidence of atopic dermatitis in children. Ital J Pediatr 2021; 47:202. [PMID: 34627353 PMCID: PMC8502347 DOI: 10.1186/s13052-021-01157-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 09/20/2021] [Indexed: 11/21/2022] Open
Abstract
Background There is growing evidence suggesting that air pollution may act as an important environmental risk factor in the development and aggravation of childhood atopic dermatitis (AD). Methods We collected data from the Taiwan National Health Insurance (NHI) research database and linked the data to the Taiwan Air Quality-Monitoring Database. From January 1, 2000 to December 31, 2012; children aged below 18 years were selected from the database and followed longitudinally until the diagnosis of AD, withdrawal from the NHI, or December 31, 2012. Children with missing data or those diagnosed with AD before enrolment in this study were excluded. We measured the incidence rate and hazard ratios (HRs) for AD and stratified them by quartiles (Q1–Q4) of air pollutant concentration. Multivariable Cox proportional hazards models were also applied by adjusting for age, sex, monthly income, and level of urbanization. Results When compared with the concentrations of pollutants in the Q1 quartile, the adjusted HR for AD increased with an increase in the exposure concentrations of total hydrocarbons (THCs), non-methane hydrocarbons (NMHCs), and methane (CH4) from 1.65 (95% confidence interval [CI]: 1.47–1.84) to 10.6 (95% CI: 5.85–7.07), from 1.14 (95% CI: 1.06–1.24) to 2.47 (95% CI: 2.29–2.66), and from 1.70 (95% CI: 1.52–1.89) to 11.9 (95% CI: 10.8–13.1), respectively. Patients exposed to higher levels of THCs, NMHCs, and CH4 exhibited greater incidence rates of childhood AD. Conclusions The present study demonstrated that exposure to higher concentrations of THCs, NMHCs, and CH4 were associated with an increased risk of childhood AD.
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Affiliation(s)
- Chieh Wang
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chang-Ching Wei
- Children's Hospital, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - Lei Wan
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,Institute of Biostatistics, China Medical University, Taichung, Taiwan
| | - Jeng-Dau Tsai
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan. .,Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan.
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Dunning HT, Boy C, Davis NL, Griffing E, Lasso-Pirot A. A hospital-based multidimensional intervention for high risk pediatric patients with asthma. J Asthma 2021; 59:1732-1741. [PMID: 34374617 DOI: 10.1080/02770903.2021.1963764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: To determine the effects of a multi-dimensional intervention (consisting of education, recommendations for medical management, and short-term case management) provided by pulmonology nurse practitioners(NP) on inpatient and post-discharge outcomes for patients admitted with asthma exacerbations to a Pediatric Intensive Care Unit(PICU).Methods: A retrospective cohort study was completed on subjects with an asthma exacerbation admitted to the PICU from 01-01-2015 to 31-12-2018. Records were reviewed for 12-months post-discharge. We compared inpatient and post-discharge outcomes for those who did vs. did not receive NP consultation. The primary outcome evaluated was optimization of discharge medications. Rates of follow up, repeat ED visits and hospitalizations were also reviewed.Results: 222 subjects met inclusion and exclusion criteria; of those, 101(45.5%) patients received NP consultation and 121(54.5%) had PICU management only. Patients with NP consultation were more likely to have controllers initiated (34.6% vs. 15%) or adjusted (55.5% vs. 33.3%) per asthma guidelines (p < 0.001). The consult group were more likely to have an asthma follow-up appointment made prior to discharge (99% vs. 45%, p < 0.001), and were more likely to attend the appointment (51% vs. 21%, p < 0.001). There were no significant differences between groups for ED visits or readmission for asthma 12-months post-discharge.Conclusions: Patients with NP consultation were more likely to have controllers started or adjusted per guidelines and were more likely to attend specialty follow-up appointments post-discharge. No impact was seen on ED visits or readmissions. Implementation of such a program may aid in optimizing asthma management and continuity of care post hospitalization.
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Affiliation(s)
- Heather T Dunning
- University of Maryland Children's Hospital, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Christine Boy
- University of Maryland Children's Hospital, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Natalie L Davis
- University of Maryland Children's Hospital, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Emily Griffing
- University of Maryland Children's Hospital, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Anayansi Lasso-Pirot
- University of Maryland Children's Hospital, University of Maryland School of Medicine, Baltimore, MD, USA
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Fong WCG, Grevatt S, Potter S, Tidbury T, Kadalayil L, Bennett K, Larsson M, Nicolas F, Kurukulaaratchy R, Arshad SH. The Efficacy of the Dyson Air Purifier in Improving Asthma Control: Protocol for a Single-Center, Investigator-Led, Randomized, Double-Blind, Placebo-Controlled Trial. JMIR Res Protoc 2021; 10:e28624. [PMID: 34313599 PMCID: PMC8367098 DOI: 10.2196/28624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/19/2021] [Accepted: 05/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background Indoor air quality has been shown to influence asthma control and outcomes. Air purifiers and high-efficiency particulate air filtration devices can improve indoor air quality by reducing the indoor levels of air pollution and allergens. However, the influence of this improved indoor air quality on asthma control remains unclear; hence, randomized controlled trials are needed to further elucidate this phenomenon. Objective This study aims to investigate the effect of reducing the levels of allergens and pollutants in the bedroom and living room through the use of Dyson air purifiers (Dyson Pure Cool) on asthma control. Methods This is an 18-month long, investigator-led, randomized, double-blinded, placebo-controlled, single-center trial. Subjects will be randomized in a 1:1 ratio to active or placebo Dyson filters. The primary outcome is the change in the scores of Asthma Control Questionnaire 6 and Asthma-specific Quality of Life Questionnaire from baseline. Secondary outcomes include changes in lung function (forced expiratory volume in one second, forced expiratory volume in one second/forced vital capacity ratio, and midexpiratory flows), peak expiratory flow measurements, airway hyperresponsiveness (assessed by methacholine bronchial challenge), fractional exhaled nitric oxide, and indoor air pollutant levels. The sample size will be 50 subjects, and all subjects will have a confirmed diagnosis of mild persistent to moderate persistent asthma along with an Asthma Control Questionnaire 6 score of >1.5. Results This study was approved by the West Midlands Research Ethics Committee (18/WM/0277). The study results will be published in peer-reviewed scientific journals; presented at relevant scientific conferences; and shared in plain English with participants in our newsletters, in our clinics, and via the David Hide Asthma and Allergy Research Centre website. Our trial began in September 2019 and is expected to end in August 2021. Conclusions This is a double-blinded, placebo-controlled, randomized, investigator-led study to investigate the efficacy of a novel air purifier in improving asthma control in adults. The trial period of 18 months will facilitate the collection of robust data and will therefore generate clear signals. However, this extended trial duration may lead to patient withdrawal. Furthermore, this trial is conducted at a single center and in a location with a homogenous cohort of people, which may affect translatability. Nonetheless, it is hoped that the findings of this trial may help further inform clinicians regarding the utility of this novel device as an adjunct in asthma care. Trial Registration ClinicalTrials.gov NCT04729530; https://clinicaltrials.gov/ct2/show/NCT04729530 International Registered Report Identifier (IRRID) DERR1-10.2196/28624
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Affiliation(s)
- Wei Chern Gavin Fong
- David Hide Asthma and Allergy Research Centre, Newport, United Kingdom.,School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Susan Grevatt
- David Hide Asthma and Allergy Research Centre, Newport, United Kingdom
| | - Stephen Potter
- David Hide Asthma and Allergy Research Centre, Newport, United Kingdom
| | - Tracey Tidbury
- David Hide Asthma and Allergy Research Centre, Newport, United Kingdom
| | - Latha Kadalayil
- David Hide Asthma and Allergy Research Centre, Newport, United Kingdom.,School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Kaisha Bennett
- David Hide Asthma and Allergy Research Centre, Newport, United Kingdom
| | - Maria Larsson
- David Hide Asthma and Allergy Research Centre, Newport, United Kingdom
| | - Frédéric Nicolas
- Dyson Technology Limited, Tetbury Hill, Malmesbury, Wiltshire, United Kingdom
| | - Ramesh Kurukulaaratchy
- David Hide Asthma and Allergy Research Centre, Newport, United Kingdom.,School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Syed Hasan Arshad
- David Hide Asthma and Allergy Research Centre, Newport, United Kingdom.,School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
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Chungag A, Engwa GA, Sewani-Rusike CR, Nkeh-Chungag BN. Effect of Seasonal Variation on the Relationship of Indoor Air Particulate Matter with Measures of Obesity and Blood Pressure in Children. J Health Pollut 2021; 11:210610. [PMID: 34267997 PMCID: PMC8276733 DOI: 10.5696/2156-9614-11.30.210610] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/15/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Particulate matter (PM) air pollution is an important environmental health risk factor. Although some studies have shown PM to be associated with obesity and hypertension, very few studies have assessed the association of indoor PM specifically with obesity and blood pressure measures in children with respect to seasonal variation. OBJECTIVES The present study investigated the relationship of PM with obesity and blood pressure variables in children across the winter and summer seasons. METHODS A comparative descriptive approach was adopted and school children from 10-14 years of age from selected rural and urban localities of the Eastern Cape Province of South Africa were assessed in winter and summer. Anthropometric measurements were taken, including height, weight, waist circumference, body mass index (BMI), and total fat mass (TFM), while blood pressure variables including systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were measured. Indoor air PM concentrations were measured in the classrooms in the presence of children. RESULTS The prevalence of obesity and hypertension in children were 13.4% and 5.1% in winter and 12.9% and 1.0% in summer, respectively. High blood pressure was more prevalent in children in rural areas, while the prevalence of obesity in children was higher in urban areas. Particulate matter was significantly (p<0.05) higher in rural areas compared to urban areas. Obese children in summer had a greater than 3-fold association (AOR: 3.681, p=0.005) with 4th interquartile range (IQR) of PM5 and a greater than 3- and 4-fold association (AOR: 3.08; 4.407; p<0.05) with 2nd and 4th IQR of PM10, respectively, than their overweight, normal weight or underweight counterparts. High blood pressure was not associated (p< 0.05) with PM. CONCLUSIONS High concentrations of indoor PM were positively associated with obesity in children in summer, particularly among rural children. This association could be accounted for by location and seasonal differences. PARTICIPANT CONSENT Obtained. ETHICS APPROVAL Ethics approval was obtained from the Health Sciences Ethics Committee of Walter Sisulu University, South Africa (Ref No: CHI011SCHU01). COMPETING INTERESTS The authors declare no competing financial interests.
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Affiliation(s)
- Anye Chungag
- Department of Geography and Environmental Sciences, Faculty of Science and Agriculture, University of Fort Hare, Alice, South Africa
| | - Godwill Azeh Engwa
- Department of Biological and Environmental Sciences, Faculty of Natural Sciences, Walter Sisulu University, Mthatha, South Africa
| | | | - Benedicta Ngwenchi Nkeh-Chungag
- Department of Biological and Environmental Sciences, Faculty of Natural Sciences, Walter Sisulu University, Mthatha, South Africa
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Effects of indoor air pollution due to solid fuel combustion on physical growth of children under 5 in Sri Lanka: A descriptive cross sectional study. PLoS One 2021; 16:e0252230. [PMID: 34033666 PMCID: PMC8148308 DOI: 10.1371/journal.pone.0252230] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 05/11/2021] [Indexed: 12/02/2022] Open
Abstract
Solid fuel combustion is an important risk factor of morbidity. This study was conducted to determine the effect of indoor air pollution (IAP) due to solid fuel combustion on physical growth in 262 Sri Lankan children under five. Exposure was defined by the type of fuel used for cooking. Pollutant levels were measured in a subsample of households. “High” exposure group (households using biomass fuel/kerosene oil for cooking) comprised 60% of the study population; the prevalence of wasting was 19.7% and underweight was 20.4% in the entire population where 68% were from the high exposure group. Children from the “high” exposure group had significantly lower mean z-scores for weight-for-height (p = 0.047), height-for-age (p = 0.004) and weight-for-age (p = 0.001) as compared to the “low” exposure group (children of households using liquefied petroleum gas and/or electricity) after adjusting for confounders. Z-scores of weight-for-age, height-for-age and weight-for-height were negatively correlated with CO (p = 0.001, 0.018, 0.020, respectively) and PM2.5 concentrations (p<0.001,p = 0.024 p = 0.008, respectively). IAP due to combustion of biomass fuel leads to poor physical growth.
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40
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Lynch KM, Mirabelli MC. Outdoor Air Quality Awareness, Perceptions, and Behaviors Among U.S. Children Aged 12-17 Years, 2015-2018. J Adolesc Health 2021; 68:882-887. [PMID: 32919887 PMCID: PMC7940452 DOI: 10.1016/j.jadohealth.2020.07.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 07/25/2020] [Accepted: 07/27/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE This study aimed to assess U.S. adolescents' perceptions and knowledge about air quality and their behaviors aimed to reduce air pollution exposure and whether they vary by demographic characteristics. METHODS We analyzed data from the Porter Novelli Public Services YouthStyles survey, a nationally representative survey of U.S. adolescents aged 12-17 years. In survey years 2015-2018, a total of 3,547 adolescents self-reported awareness, perceptions, and behaviors related to air pollution. We calculated weighted percentages of respondents reporting each aspect of air quality awareness, perception, and behaviors overall and by categories of age, gender, parental education, metropolitan status, region, and survey year. RESULTS Overall, an estimated 81% of U.S. adolescents thought outdoor air pollution could impact health, 52% thought there were things they could do to limit their or their family's exposure, 19% were aware of air quality alerts, 46% of those who thought or were informed air quality was bad did something differently, and 19% always or usually avoided busy roads to reduce air pollution exposure; differences were reported by some demographic variables. CONCLUSIONS Among U.S. adolescents, awareness that air pollution could impact health was relatively high. However, gaps were found in the awareness of the potential impacts and other aspects of awareness and perceptions related to air pollution and the engagement in behaviors to reduce exposure, some of which varied by demographic characteristics. These results can be used to inform interventions that increase awareness and behaviors to reduce air pollution exposures among U.S. adolescents.
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Affiliation(s)
- Katie M Lynch
- Asthma and Community Health Branch, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Maria C Mirabelli
- Asthma and Community Health Branch, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
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41
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Koelmel JP, Lin EZ, Nichols A, Guo P, Zhou Y, Godri Pollitt KJ. Head, Shoulders, Knees, and Toes: Placement of Wearable Passive Samplers Alters Exposure Profiles Observed. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2021; 55:3796-3806. [PMID: 33625210 DOI: 10.1021/acs.est.0c05522] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Chemical exposures are a major risk factor for many diseases. Comprehensive characterization of personal exposures is necessary to highlight chemicals of concern and factors that influence these chemical exposure dynamics. For this purpose, wearable passive samplers can be applied to assess longitudinal personal exposures to airborne contaminants. Questions remain regarding the impact of sampler placement at different locations of the body on the exposure profiles observed and how these placements affect the monitoring of seasonal dynamics in exposures. This study assessed personal air contaminant exposure using passive samplers worn in parallel across 32 participant's wrists, chest, and shoes over 24 h. Samplers were analyzed by thermal desorption gas chromatography high-resolution mass spectrometry. Personal exposure profiles were similar for about one-third of the 275 identified chemicals, irrespective of sampler placement. Signals of certain semivolatile organic compounds (SVOCs) were enhanced in shoes and, to a lesser extent, wrist samplers, as compared to those in chest samplers. Signals of volatile organic compounds were less impacted by sampler placement. Results showed that chest samplers predominantly captured more volatile exposures, as compared to those of particle-bound exposures, which may indicate predominant monitoring of chemicals via the inhalation route of exposure for chest samplers. In contrast, shoe samplers were more sensitive to particle-bound SVOCs. Seventy-one chemicals changed across participants between winter and summer in the same manner for two or more different sampler placements on the body, whereas 122 chemicals were observed to have seasonal differences in only one placement. Hence, the placement in certain cases significantly impacts exposure dynamics observed. This work shows that it is essential in epidemiological studies undertaking exposure assessment to consider the consequence of the placement of exposure monitors.
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Affiliation(s)
- Jeremy P Koelmel
- Department of Environmental Health Sciences, Yale School of Public Health, 60 College Street, New Haven, Connecticut 06510, United States
| | - Elizabeth Z Lin
- Department of Environmental Health Sciences, Yale School of Public Health, 60 College Street, New Haven, Connecticut 06510, United States
| | - Amy Nichols
- Department of Chemical and Environmental Engineering, Yale University, 17 Hillhouse Avenue, New Haven, Connecticut 06520, United States
| | - Pengfei Guo
- Department of Environmental Health Sciences, Yale School of Public Health, 60 College Street, New Haven, Connecticut 06510, United States
| | - Yakun Zhou
- Department of Environmental Health Sciences, Yale School of Public Health, 60 College Street, New Haven, Connecticut 06510, United States
| | - Krystal J Godri Pollitt
- Department of Environmental Health Sciences, Yale School of Public Health, 60 College Street, New Haven, Connecticut 06510, United States
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Brigham E, Allbright K, Harris D. Health Disparities in Environmental and Occupational Lung Disease. Clin Chest Med 2021; 41:623-639. [PMID: 33153683 DOI: 10.1016/j.ccm.2020.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Pulmonary health disparities disproportionately impact disadvantaged and vulnerable populations. This article focuses on disparities in disease prevalence, morbidity, and mortality for asthma, chronic obstructive pulmonary disease, pneumoconiosis, and lung cancer. Disparities are categorized by race, age, sex, socioeconomic status, and geographic region. Each category highlights differences in risk factors for the development and severity of lung disease. Risk factors include social, behavioral, economic, and biologic determinants of health (occupational/environmental exposures, psychosocial stressors, smoking, health literacy, health care provider bias, and health care access). Many of these risk factors are complex and inter-related; strategies proposed to decrease disparities require multilevel approaches.
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Affiliation(s)
- Emily Brigham
- Division of Pulmonary and Critical Care, Johns Hopkins University, 1830 East Monument Street 5th Floor, Baltimore, MD 21287, USA. https://twitter.com/emily_brigham
| | - Kassandra Allbright
- Department of Medicine, Johns Hopkins University, 1830 East Monument Street 5th Floor, Baltimore, MD 21287, USA
| | - Drew Harris
- Division of Pulmonary and Critical Care and Public Health Sciences, University of Virginia, Pulmonary Clinic 2nd Floor, 1221 Lee Street, Charlottesville, VA 22903, USA.
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43
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Raju S, Siddharthan T, McCormack MC. Indoor Air Pollution and Respiratory Health. Clin Chest Med 2021; 41:825-843. [PMID: 33153698 DOI: 10.1016/j.ccm.2020.08.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Worldwide, more than 4 million deaths annually are attributed to indoor air pollution. This largely preventable exposure represents a key target for reducing morbidity and mortality worldwide. Significant respiratory health effects are observed, ranging from attenuated lung growth and development in childhood to accelerated lung function decline and is determined by chronic obstructive pulmonary disease later in life. Personal exposure to household air pollutants include household characteristics, combustion of solid fuels, cooking practices, and household pest allergens. This review outlines important sources of indoor air pollution, their respiratory health effects, and strategies to reduce household pollution and improve lung health across the globe.
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Affiliation(s)
- Sarath Raju
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Johns Hopkins School of Medicine, 1830 East Monument Street Fifth Floor, Baltimore, MD, 21287, USA.
| | - Trishul Siddharthan
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Johns Hopkins School of Medicine, 1830 East Monument Street Fifth Floor, Baltimore, MD, 21287, USA
| | - Meredith C McCormack
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Johns Hopkins School of Medicine, 1830 East Monument Street Fifth Floor, Baltimore, MD, 21287, USA
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Xiao S, Ngo AL, Mendola P, Bates MN, Barcellos AL, Ferrara A, Zhu Y. Household mold, pesticide use, and childhood asthma: A nationwide study in the U.S. Int J Hyg Environ Health 2021; 233:113694. [PMID: 33556714 DOI: 10.1016/j.ijheh.2021.113694] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/13/2021] [Accepted: 01/22/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate the associations of household mold and pesticide use with risk of childhood asthma and examine the potential effect modification by child's sex at a national level in the U.S. METHODS Nationally representative data were drawn from the cross-sectional 2017 and 2018 National Surveys of Children's Health. Household mold and pesticide exposures during the past 12 months and physician-diagnosed childhood asthma were assessed by standard questionnaires administered to primary caregivers. Multivariable logistic regression models were used to calculate adjusted odds ratios (aOR) for current asthma, adjusting for child, caregiver, and household covariates. We also examined potential effect modification by child's sex. Sampling weights accounted for the complex survey design. RESULTS Among 41,423 U.S. children in 2017-2018, the weighted prevalence of current asthma was 10.8% in household mold-exposed children, compared with 7.2% in non-exposed children (P < 0.001). After adjusting for covariates including child's obesity, children with household mold exposure compared to those with no household mold exposure had a 1.41-fold (95% CI: 1.07, 1.87) higher odds of current asthma. Associations between household mold and current asthma were pronounced among boys (aOR 1.57; 95% CI: 1.03-2.38) but not girls (aOR 1.28; 0.90-1.83; P for interaction <0.001). No significant associations were observed between household pesticide use and current asthma, after adjusting for covariates. CONCLUSIONS Our findings suggest that household mold is associated with current asthma among children, independent of other major risk factors including child's obesity status. Our findings may inform strategies targeting mitigation of household mold as an important indoor environment factor to address childhood asthma.
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Affiliation(s)
- Siyuan Xiao
- School of Public Health, University of California, Berkeley, United States
| | - Amanda L Ngo
- Kaiser Permanente Northern California Division of Research, Oakland, CA, United States
| | - Pauline Mendola
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States
| | - Michael N Bates
- School of Public Health, University of California, Berkeley, United States
| | - Anna L Barcellos
- School of Public Health, University of California, Berkeley, United States
| | - Assiamira Ferrara
- Kaiser Permanente Northern California Division of Research, Oakland, CA, United States
| | - Yeyi Zhu
- Kaiser Permanente Northern California Division of Research, Oakland, CA, United States; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States.
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Koelmel JP, Lin EZ, Guo P, Zhou J, He J, Chen A, Gao Y, Deng F, Dong H, Liu Y, Cha Y, Fang J, Beecher C, Shi X, Tang S, Godri Pollitt KJ. Exploring the external exposome using wearable passive samplers - The China BAPE study. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2021; 270:116228. [PMID: 33360595 DOI: 10.1016/j.envpol.2020.116228] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 06/12/2023]
Abstract
Environmental exposures are one of the greatest threats to human health, yet we lack tools to answer simple questions about our exposures: what are our personal exposure profiles and how do they change overtime (external exposome), how toxic are these chemicals, and what are the sources of these exposures? To capture variation in personal exposures to airborne chemicals in the gas and particulate phases and identify exposures which pose the greatest health risk, wearable exposure monitors can be deployed. In this study, we deployed passive air sampler wristbands with 84 healthy participants (aged 60-69 years) as part of the Biomarkers for Air Pollutants Exposure (China BAPE) study. Participants wore the wristband samplers for 3 days each month for five consecutive months. Passive samplers were analyzed using a novel gas chromatography high resolution mass spectrometry data-processing workflow to overcome the bottleneck of processing large datasets and improve confidence in the resulting identified features. The toxicity of chemicals observed frequently in personal exposures were predicted to identify exposures of potential concern via inhalation route or other routes of airborne contaminant exposure. Three exposures were highlighted based on elevated toxicity: dichlorvos from insecticides (mosquito/malaria control), naphthalene partly from mothballs, and 183 polyaromatic hydrocarbons from multiple sources. Other exposures explored in this study are linked to diet and personal care products, cigarette smoke, sunscreen, and antimicrobial soaps. We highlight the potential for this workflow employing wearable passive samplers for prioritizing chemicals of concern at both the community and individual level, and characterizing sources of exposures for follow up interventions.
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Affiliation(s)
- Jeremy P Koelmel
- Department of Environmental Health Sciences, School of Public Health, Yale University, New Haven, CT, 06520, USA
| | - Elizabeth Z Lin
- Department of Environmental Health Sciences, School of Public Health, Yale University, New Haven, CT, 06520, USA
| | - Pengfei Guo
- Department of Environmental Health Sciences, School of Public Health, Yale University, New Haven, CT, 06520, USA
| | - Jieqiong Zhou
- Department of Environmental Health Sciences, School of Public Health, Yale University, New Haven, CT, 06520, USA
| | - Jucong He
- Department of Environmental Health Sciences, School of Public Health, Yale University, New Haven, CT, 06520, USA
| | - Alex Chen
- Department of Computer Science, Yale University, New Haven, CT, 06520, USA
| | - Ying Gao
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, 100021, China
| | - Fuchang Deng
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, 100021, China
| | - Haoran Dong
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, 100021, China
| | - Yuanyuan Liu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, 100021, China
| | - Yu'e Cha
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, 100021, China
| | - Jianlong Fang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, 100021, China
| | | | - Xiaoming Shi
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, 100021, China; Center for Global Health, Nanjing Medical University, Nanjing, Jiangsu, 211166, China
| | - Song Tang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, 100021, China; Center for Global Health, Nanjing Medical University, Nanjing, Jiangsu, 211166, China
| | - Krystal J Godri Pollitt
- Department of Environmental Health Sciences, School of Public Health, Yale University, New Haven, CT, 06520, USA.
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Chatkin J, Correa L, Santos U. External Environmental Pollution as a Risk Factor for Asthma. Clin Rev Allergy Immunol 2021; 62:72-89. [PMID: 33433826 PMCID: PMC7801569 DOI: 10.1007/s12016-020-08830-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 12/12/2022]
Abstract
Air pollution is a worrisome risk factor for global morbidity and mortality and plays a special role in many respiratory conditions. It contributes to around 8 million deaths/year, with outdoor exposure being responsible for more than 4.2 million deaths throughout the world, while more than 3.8 million die from situations related to indoor pollution. Pollutant agents induce several respiratory symptoms. In addition, there is a clear interference in numerous asthma outcomes, such as incidence, prevalence, hospital admission, visits to emergency departments, mortality, and asthma attacks, among others. The particulate matter group of pollutants includes coarse particles/PM10, fine particles/PM2.5, and ultrafine particles/PM0.1. The gaseous components include ground-level ozone, nitrogen dioxide, sulfur dioxide, and carbon monoxide. The timing, load, and route of allergen exposure are other items affecting allergic disease phenotypes. The complex interaction between pollutant exposures and human host factors has an implication in the development and rise of asthma as a public health problem. However, there are hiatuses in the understanding of the pathways in this disease. The routes through which pollutants induce asthma are multiple, and include the epigenetic changes that occur in the respiratory tract microbiome, oxidative stress, and immune dysregulation. In addition, the expansion of the modern Westernized lifestyle, which is characterized by intense urbanization and more time spent indoors, resulted in greater exposure to polluted air. Another point to consider is the different role of the environment according to age groups. Children growing up in economically disadvantaged neighborhoods suffer more important negative health impacts. This narrative review highlights the principal polluting agents, their sources of emission, epidemiological findings, and mechanistic evidence that links environmental exposures to asthma.
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Affiliation(s)
- Jose Chatkin
- Pulmonology Division, School of Medicine, Pontifical Catholic University Rio Grande Do Sul (PUCRS), Hospital São Lucas da PUCRS, Porto Alegre, Brazil.
| | - Liana Correa
- Health Sciences Doctorate Program, School of Medicine, Pontifical Catholic University Rio Grande Do Sul (PUCRS), Pulmonologist Hospital São Lucas da PUCRS, Porto Alegre, Brazil
| | - Ubiratan Santos
- Pulmonology Division of Instituto Do Coração, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
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Abstract
Rationale: Approximately 8% of the U.S. population suffers from asthma, a chronic condition. It poses a substantial economic burden to society in the form of lost productivity and healthcare costs.Objectives: We use the Medical Expenditure Panel Survey 2002-2010 to quantify the lifetime costs of asthma at each age, the impact of adult asthma on earnings and choice of occupation, and the impact of childhood asthma on parental income.Methods: We developed a framework to estimate the present discounted value of the cumulative lifetime asthma-related healthcare costs and lost productivity experienced by an individual after onset. This approach allows for age- and asthma duration-related variability in annual costs as well as for the intermittent nature of asthma symptoms.Results: Estimated asthma-related annual healthcare expenditures across all life stages are $700-$2,200 (2010 U.S. dollars). Lost annual earnings among individuals aged 30-49 are over $4,000 (2010 U.S. dollars). The present discounted value of the cumulative lifetime healthcare costs and lost productivity for a new case of asthma is estimated at $36,500 using the 3% discount rate (2010 U.S. dollars).Conclusions: The economic burden of asthma is substantial and larger than previously estimated, reflecting expenditures on treatment and lost earnings.
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Branco PTBS, Alvim-Ferraz MCM, Martins FG, Ferraz C, Vaz LG, Sousa SIV. Impact of indoor air pollution in nursery and primary schools on childhood asthma. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 745:140982. [PMID: 32736106 DOI: 10.1016/j.scitotenv.2020.140982] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/09/2020] [Accepted: 07/13/2020] [Indexed: 05/05/2023]
Abstract
Poor indoor air quality in scholar environments have been frequently reported, but its impact on respiratory health in schoolchildren has not been sufficiently explored. Thus, this study aimed to evaluate the associations between children's exposure to indoor air pollution (IAP) in nursery and primary schools and childhood asthma. Multivariate models (independent and multipollutant) quantified the associations of children's exposure with asthma-related health outcomes: reported active wheezing, reported and diagnosed asthma, and lung function (reduced FEV1/FVC and reduced FEV1). A microenvironmental modelling approach estimated individual inhaled exposure to major indoor air pollutants (CO2, CO, formaldehyde, NO2, O3, TVOC, PM2.5 and PM10) in nursery and primary schools from both urban and rural sites in northern Portugal. Questionnaires and medical tests (spirometry pre- and post-bronchodilator) were used to obtain information on health outcomes and to diagnose asthma following the newest international clinical guidelines. After testing children for aeroallergen sensitisation, multinomial models estimated the effect of exposure to particulate matter on asthma in sensitised individuals. The study population were 1530 children attending nursery and primary schools, respectively 648 pre-schoolers (3-5 years old) and 882 primary school children (6-10 years old). This study found no evidence of a significant association between IAP in nursery and primary schools and the prevalence of childhood asthma. However, reported active wheezing was associated with higher NO2, and reduced FEV1 was associated with higher O3 and PM2.5, despite NO2 and O3 in schools were always below the 200 μg m-3 threshold from WHO and National legislation, respectively. Moreover, sensitised children to common aeroallergens were more likely to have asthma during childhood when exposed to particulate matter in schools. These findings support the urgent need for mitigation measures to reduce IAP in schools, reducing its burden to children's health.
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Affiliation(s)
- Pedro T B S Branco
- LEPABE - Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - Maria C M Alvim-Ferraz
- LEPABE - Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - Fernando G Martins
- LEPABE - Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - Catarina Ferraz
- Departamento de Pediatria (UAG-MC), Centro Hospitalar Universitário de São João (CHUSJ), Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Luísa G Vaz
- Departamento de Pediatria (UAG-MC), Centro Hospitalar Universitário de São João (CHUSJ), Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Sofia I V Sousa
- LEPABE - Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal.
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Kim S, Lee J, Park S, Rudasingwa G, Lee S, Yu S, Lim DH. Association between Peak Expiratory Flow Rate and Exposure Level to Indoor PM2.5 in Asthmatic Children, Using Data from the Escort Intervention Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207667. [PMID: 33096665 PMCID: PMC7589683 DOI: 10.3390/ijerph17207667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/06/2020] [Accepted: 10/15/2020] [Indexed: 12/23/2022]
Abstract
Various studies have indicated that particulate matter <2.5 μm (PM2.5) could cause adverse health effects on pulmonary functions in susceptible groups, especially asthmatic children. Although the impact of ambient PM2.5 on children’s lower respiratory health has been well-established, information regarding the associations between indoor PM2.5 levels and respiratory symptoms in asthmatic children is relatively limited. This randomized, crossover intervention study was conducted among 26 asthmatic children’s homes located in Incheon metropolitan city, Korea. We aimed to evaluate the effects of indoor PM2.5 on children’s peak expiratory flow rate (PEFR), with a daily intervention of air purifiers with filter on, compared with those groups with filter off. Children aged between 6–12 years diagnosed with asthma were enrolled and randomly allocated into two groups. During a crossover intervention period of seven weeks, we observed that, in the filter-on group, indoor PM2.5 levels significantly decreased by up to 43%. (p < 0.001). We also found that the daily or weekly unit (1 μg/m3) increase in indoor PM2.5 levels could significantly decrease PEFR by 0.2% (95% confidence interval (CI) = 0.1 to 0.5) or PEFR by 1.2% (95% CI = 0.1 to 2.7) in asthmatic children, respectively. The use of in-home air filtration could be considered as an intervention strategy for indoor air quality control in asthmatic children’s homes.
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Affiliation(s)
- Sungroul Kim
- Department of Environmental Sciences, Soonchunhyang University, Asan 31538, Korea; (J.L.); (S.P.); (G.R.); (S.Y.)
- Department of ICT Environmental Health System, Graduate School, Soonchunhyang University, Asan 31538, Korea;
- Correspondence: ; Tel.: +82-41-530-1266
| | - Jungeun Lee
- Department of Environmental Sciences, Soonchunhyang University, Asan 31538, Korea; (J.L.); (S.P.); (G.R.); (S.Y.)
| | - Sujung Park
- Department of Environmental Sciences, Soonchunhyang University, Asan 31538, Korea; (J.L.); (S.P.); (G.R.); (S.Y.)
| | - Guillaume Rudasingwa
- Department of Environmental Sciences, Soonchunhyang University, Asan 31538, Korea; (J.L.); (S.P.); (G.R.); (S.Y.)
| | - Sangwoon Lee
- Department of ICT Environmental Health System, Graduate School, Soonchunhyang University, Asan 31538, Korea;
| | - Sol Yu
- Department of Environmental Sciences, Soonchunhyang University, Asan 31538, Korea; (J.L.); (S.P.); (G.R.); (S.Y.)
| | - Dae Hyun Lim
- Department of Pediatrics, School of Medicine, Inha University, Incheon 22332, Korea;
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Krishna MT, Mahesh PA, Vedanthan PK, Mehta V, Moitra S, Christopher DJ. Pediatric allergic diseases in the Indian subcontinent-Epidemiology, risk factors and current challenges. Pediatr Allergy Immunol 2020; 31:735-744. [PMID: 32521565 DOI: 10.1111/pai.13306] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION India is low-middle-income country (LMIC) with a population of 1.3bn, comprising about 20% of the global population. While the high-income Western countries faced an "allergy epidemic" during the last three decades, there has been a gradual rise in prevalence of allergic diseases in India. METHODS Narrative review. RESULTS AND DISCUSSION Allergic diseases occur as a consequence of a complex interplay between genetic and environmental factors. There are multiple contrasting determinants that are important to consider in India including high levels of air pollution, in particular PM2.5 due to burning of fossil fuels and biomass fuels, diverse aero-biology, tropical climate, cultural and social diversity, religious beliefs/myths, linguistic diversity, literacy level, breastfeeding and weaning, diet (large proportion vegetarian), and high incidence rates of TB, HIV, malaria, filariasis, parasitic infestations, and others, that not only shape the immune system early in life, but also impact on biomarkers relevant to allergic diseases. India has a relatively weak and heterogeneous healthcare framework, and allergology has not yet been recognized as an independent specialty. There are very few post-graduate training programs, and allergic diseases are managed by primary care physicians, organ-based specialists, and general pediatricians. Adrenaline auto-injectors are not available, there is patient unaffordability for inhalers, nasal sprays, and biologics, and this is compounded by poor compliance leading to 40%-50% of asthmatic children having uncontrolled disease and high rates of oral corticosteroid use. Standardized allergen extracts are not available for skin tests and desensitization. This article provides a critical analysis of pediatric allergic diseases in India.
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Affiliation(s)
- Mamidipudi Thirumala Krishna
- Allergy and Immunology Department, University Hospitals Birmingham NHS Foundation Trust and Institute of Immunology & Immunotherapy, University of Birmingham, Birmingham, UK
| | | | - Pudupakkam K Vedanthan
- Department of Medicine, Division of Allergy and Immunology, The University of Colorado, Aurora, CO, USA
| | - Vinay Mehta
- Allergy, Asthma and Immunology Associates, Lincoln, NE, USA
| | - Saibal Moitra
- Department of Allergy and Immunology, Apollo Gleneagles Hospital, Kolkata, West Bengal, India
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