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Norbäck D, Hashim JH, Hashim Z, Jalaludin J, Ismail R, Wieslander G, Wispriyono B, Sary L, Pratama S, Sari M, Sisinta T, Putra H, Perdana AA, Muhani N, Lestari SMP, Wulandari R, Nurmala EE. Fractional exhaled nitric oxide (FeNO) among school children in Java and Sumatra, Indonesia: associations with respiratory symptoms, house dust mite sensitization and the home environment. J Asthma 2024:1-9. [PMID: 39066997 DOI: 10.1080/02770903.2024.2383627] [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: 03/26/2024] [Revised: 07/12/2024] [Accepted: 07/19/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE To study associations between fractional exhaled nitric oxide (FeNO) and asthma, airway symptoms, sensitization to common allergens, outdoor pollution and home environment among 380 students in eight junior high schools in two areas in Indonesia. METHODS Data on health and home were collected by a face-to face interview before measuring FeNO and performing skin prick test against common allergens. Exploratory linear mixed and logistic regression models were employed. RESULTS Geometric mean of FeNO was 17.8 ppb (GSD 2.09) and 139 students (36.6%) had elevated FeNO (>20 ppb). In total, 107 students (28.2%) were sensitized to house dust mite (HDM) (Der p1 or Der f1), 4 (1.1%) to cat and 3 (0.8%) to mold (Cladosporium or Alternaria). Moreover, 20 students (5.3%) had diagnosed asthma, 38 (10.0%) had current wheeze, and 107 (28.2%) had current rhinitis. HDM sensitization, diagnosed asthma, current wheeze, and current rhinitis were associated with FeNO. In total, 281 students (73.9%) had mold or dampness, 232 (61.1%) had environmental tobacco smoke (ETS) and 43 (11.3%) had other odor at home. Indoor mold or dampness and other odor at home were associated with FeNO. ETS was negatively associated with FeNO. CONCLUSION HDM sensitization and elevated FeNO can be common among children in this part of Indonesia. The high prevalence of elevated FeNO indicate that undiagnosed childhood asthma is common. Dampness, mold and odor at home can be associated with increased FeNO while ETS can be associated with decreased FeNO.
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Affiliation(s)
- Dan Norbäck
- Uppsala University, Department of Medical Science, Occupational and Environmental Medicine, University Hospital, Uppsala, Sweden
| | - Jamal Hisham Hashim
- United Nations University-International Institute for Global Health, Kuala Lumpur, Malaysia
- Department of Environmental Health and Occupational Safety, Faculty of Health Sciences, Universiti Selangor, Shah Alam, Selangor, Malaysia
| | - Zailina Hashim
- Department of Environmental and Occupational Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Juliana Jalaludin
- Department of Environmental and Occupational Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Rohaida Ismail
- Environmental Health Research Centre, Institute for Medical Research, National Institues for Health, Ministry of Health, Setia Alam, Selangor, Malaysia
| | - Gunilla Wieslander
- Uppsala University, Department of Medical Science, Occupational and Environmental Medicine, University Hospital, Uppsala, Sweden
| | - Bambang Wispriyono
- Center for Industrial and Environmental Health, Faculty of Public Health, University of Indonesia, Depok, Indonesia
| | - Lolita Sary
- Faculty of Medicine, Universitas Malahayati, Bandar Lampung, Indonesia
| | - Satria Pratama
- Faculty of Military Medicine, Indonesia Defense University, Jakarta, Indonesia
| | - Meliana Sari
- FIKES Universitas Islam Syarif Hidayatullah, Jakarta, Indonesia
| | | | | | - Agung Aji Perdana
- Faculty of Medicine, Universitas Malahayati, Bandar Lampung, Indonesia
| | - Nova Muhani
- Faculty of Medicine, Universitas Malahayati, Bandar Lampung, Indonesia
| | | | - Ririn Wulandari
- Faculty of Medicine, Universitas Malahayati, Bandar Lampung, Indonesia
| | - Eliza Eka Nurmala
- Faculty of Medicine, Universitas Malahayati, Bandar Lampung, Indonesia
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Norbäck D, Hashim JH, Hashim Z, Wieslander G. Fractional exhaled nitric oxide (FeNO) and respiratory symptoms in junior high school students in Penang, Malaysia: the role of household exposure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024; 34:213-224. [PMID: 36335594 DOI: 10.1080/09603123.2022.2143482] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
We studied associations between fractional exhaled nitric oxide (FeNO), health and household exposure among school children (N = 348) in Penang, Malaysia. Multiple logistic regression and linear mixed models were applied. Overall, 46.0% had elevated FeNO (>20 ppb) and 10.6% diagnosed asthma. Male gender (p = 0.002), parental asthma or allergy (p = 0.047), cat allergy (p = 0.009) and seafood allergy (p < 0.001), diagnosed asthma (p = 0.001), wheeze (p = 0.001), ocular symptoms (p = 0.001), rhinitis (p = 0.002) and respiratory infections (p = 0.004) were all associated with FeNO. Students exposed to ETS had lower FeNO (p = 0.05). Dampness and mould was associated with wheeze (p = 0.038), especially in wooden homes (interaction p = 0.042) and among students with elevated FeNO (interaction p = 0.024). Cat keeping increased rhinitis (p = 0.041) and respiratory infections (p = 0.008) and modified the dampness associations. In conclusion, FeNO can be associated with ocular and respiratory symptoms. Elevated FeNO, cat keeping and a wooden house can enhance the risk of wheeze when exposed to dampness and mould.
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Affiliation(s)
- Dan Norbäck
- Department of Medical Science, Occupational and Environmental Medicine, University Hospital, Uppsala, Sweden
| | - Jamal Hisham Hashim
- Department of Environmental Health and Occupational Safety, Universiti Selangor, Shah Alam, Malaysia
| | - Zailina Hashim
- Department of Environmental and Occupational Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Gunilla Wieslander
- Department of Medical Science, Occupational and Environmental Medicine, University Hospital, Uppsala, Sweden
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Werthmann D, van Wendel de Joode B, Cuffney MT, Reich BJ, Soto-Martinez ME, Corrales-Vargas A, Palomo-Cordero L, Peñaloza-Castañeda J, Hoppin JA. A cross-sectional analysis of medical conditions and environmental factors associated with fractional exhaled nitric oxide (FeNO) in women and children from the ISA birth cohort, Costa Rica. ENVIRONMENTAL RESEARCH 2023; 233:116449. [PMID: 37356534 PMCID: PMC10529647 DOI: 10.1016/j.envres.2023.116449] [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: 12/07/2022] [Revised: 06/13/2023] [Accepted: 06/16/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Fractional exhaled nitric oxide (FeNO) is a marker of airway inflammation. Elevated FeNO has been associated with environmental exposures, however, studies from tropical countries are limited. Using data from the Infants' Environmental Health Study (ISA) birth cohort, we evaluated medical conditions and environmental exposures' association with elevated FeNO. METHODS We performed a cross-sectional analysis of 277 women and 293 8-year old children who participated in the 8-year post-partum visit in 2019. We measured FeNO and collected information on medical conditions and environmental exposures including smoke from waste burning, work in banana plantations, and home pesticide use. We defined elevated FeNO as >25 ppb for women and >20 ppb for children. To evaluate factors associated with elevated FeNO, we used logistic regression models adjusted for obesity in women and unadjusted in children. RESULTS Overall elevated FeNO was common (20% of women, 13% of children). Rhinitis diagnosis was significantly associated with elevated FeNO in both women (odds ratio (OR): 3.67 95% Confidence Interval (CI): 1.81,7.35) and children (OR: 8.18 95%CI: 3.15, 21.22); wheeze was associated with elevated FeNO in women (OR: 4.50 95% CI: 2.25, 8.99). Environmental exposures were associated with elevated FeNO, but not significantly. Waste burning was associated with elevated FeNO in both women (OR: 1.58 95%CI 0.68, 4.15) and children (OR: 2.49 95%CI:0.82, 10.79). Para-occupational pesticide exposures were associated with elevated FeNO in women and children. For women, having a partner working in agriculture was associated with elevated FeNO (OR: 1.61 95%CI:0.77, 3.58) and for children, maternal work in agriculture was associated with elevated FeNO. (OR 2.08 95%CI 0.86, 4.67) CONCLUSION: Rhinitis and wheeze were associated with elevated FeNO in this rural, agricultural population. Smoke from waste burning as well as para-occupational pesticide exposure may contribute to elevated FeNO in rural communities.
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Affiliation(s)
- Derek Werthmann
- Department of Biological Sciences, NC State University, Raleigh, NC, USA; Center for Human Health and the Environment, NC State University, Raleigh, NC, USA
| | - Berna van Wendel de Joode
- Infants Environmental Health Program (ISA) Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia, Costa Rica
| | - Michael T Cuffney
- Department of Biological Sciences, NC State University, Raleigh, NC, USA
| | - Brian J Reich
- Center for Human Health and the Environment, NC State University, Raleigh, NC, USA; Department of Statistics, NC State University, Raleigh, NC, USA
| | | | - Andrea Corrales-Vargas
- Infants Environmental Health Program (ISA) Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia, Costa Rica
| | - Luis Palomo-Cordero
- Infants Environmental Health Program (ISA) Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia, Costa Rica
| | - Jorge Peñaloza-Castañeda
- Infants Environmental Health Program (ISA) Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia, Costa Rica
| | - Jane A Hoppin
- Department of Biological Sciences, NC State University, Raleigh, NC, USA; Center for Human Health and the Environment, NC State University, Raleigh, NC, USA.
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[History of atopy reduces predictive value of fractional exhaled nitric oxide for eosinophilic airway inflammation in chronic cough]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2022; 42:1470-1475. [PMID: 36329580 PMCID: PMC9637498 DOI: 10.12122/j.issn.1673-4254.2022.10.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
OBJECTIVE To investigate the impact of a history of atopy on the value of fractional exhaled nitric oxide (FENO) for predicting sputum eosinophils in patients with chronic cough. METHODS A total of 868 patients with persistent cough lasting more than 3 weeks without pulmonary infection were enrolled, including 119 patients with subacute cough (defined as cough lasting 3-8 weeks) and 749 with chronic cough (longer than 8 weeks). The predictive value of FENO level for sputum eosinophilia was analyzed using receiver-operating characteristic (ROC) curve analysis, and the area under the curve (AUC) was calculated. The atopy status of the patients was determined by screening for history of allergy, hay fever, or animal or food allergies. RESULTS Of the 868 patients enrolled, 173 patients (19.9%) had eosinophilic airway inflammation (EAI). In the overall patients, the median (Q1, Q3) FENO level was 18 (12, 35) ppb, ranging from 5 to 300 ppb. The patients with chronic cough and a positive history of atopy had a higher median FENO level than those without atopy (24 [13, 50] vs 18 [11, 34]; Z=2.25, P= 0.029), and FENO level was significantly correlated with EAI (r=0.281, P < 0.001). The AUCs of FENO for diagnosis of airway eosinophilia in patients with atopy and those without atopy were 0.677 (95% CI: 0.548-0.806) and 0.708 (95% CI: 0.660-0.756), respectively. The optimal cut-off value of FENO for diagnosing EAI was higher in patients with atopy than in those without atopy (72 vs 28.5 ppb). CONCLUSION A history of atopy reduces the predictive value of FENO level for EAI in patients with chronic cough, suggesting the importance of examining the atopic status when interpreting test results of FENO.
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Zhang Z, Zhang H, Yang L, Chen X, Norbäck D, Zhang X. Associations between outdoor air pollution, ambient temperature and fraction of exhaled nitric oxide (FeNO) in university students in northern China - A panel study. ENVIRONMENTAL RESEARCH 2022; 212:113379. [PMID: 35513063 DOI: 10.1016/j.envres.2022.113379] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 03/31/2022] [Accepted: 04/25/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Northern China has severe air pollution, especially in winter. Fractional exhaled nitric oxide (FeNO) is an established biomarker of airway inflammation. AIM To study associations between ambient temperature, air pollution and FeNO in university students in northern China. METHODS We performed a panel study in 67 university students without asthma diagnosis in the city of Taiyuan. FeNO was measured 6 times, over one heating season. Outdoor PM10, PM2.5, SO2, NO2 and O3 were measured at a fixed location in the campus. SO2, NO2 and O3 were measured 7 days (24 h/day) before the FeNO test. PM2.5 and PM10 were measured at different lag times (lag 1 day to lag 7 days). Temperature and carbon monoxide (CO) data were collected from a nearby monitoring station (lag 7). Linear mixed models were applied to study associations between exposure and FeNO, adjusting for gender, age, current smoking, height and furry pet or pollen allergy. RESULTS The overall geometric mean (GM) of FeNO was 17.2 ppb. GM of FeNO was lowest (12.9 ppb) in January and highest (20.0 ppb) in April. The range of lag 7 pollution was 105.0-339.0 μg/m3 for PM10, 72.0-180.0 μg/m3 for PM2.5, 36.0-347.0 μg/m3 for SO2, 26.0-69.0 μg/m3 for NO2, 31.0-163.0 μg/m3 for O3 and 0.93-3.14 mg/m3 for CO. The lag 7 temperature ranged from -4.5 to 20.1 °C. FeNO was consistently higher at higher outdoor temperature (p < 0.001). In multi-pollutant models with temperature adjustment, PM10, PM2.5 and SO2 were associated with FeNO (all p-values <0.001). In contrast, CO was negatively associated (protective) with FeNO (p < 0.001). Associations between exposure and FeNO were similar in men and women. CONCLUSION PM10, PM2.5 and SO2 and outdoor temperature can be associated with airway inflammation, measured as FeNO, in young adults in northern China while CO could be negatively associated with FeNO.
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Affiliation(s)
- Zefei Zhang
- Guangdong Key Laboratory of Environmental Catalysis and Health Risk Control, School of Environmental Science and Engineering, Institute of Environmental Health and Pollution Control, Guangdong University of Technology, Guangzhou, China; Institute of Environmental Science, Shanxi Laboratory for Yellow River, Shanxi University, Taiyuan, China
| | - Huilin Zhang
- Institute of Environmental Science, Shanxi Laboratory for Yellow River, Shanxi University, Taiyuan, China
| | - Liu Yang
- Institute of Environmental Science, Shanxi Laboratory for Yellow River, Shanxi University, Taiyuan, China
| | - Xingyi Chen
- Institute of Environmental Science, Shanxi Laboratory for Yellow River, Shanxi University, Taiyuan, China
| | - Dan Norbäck
- Institute of Environmental Science, Shanxi Laboratory for Yellow River, Shanxi University, Taiyuan, China; Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
| | - Xin Zhang
- Guangdong Key Laboratory of Environmental Catalysis and Health Risk Control, School of Environmental Science and Engineering, Institute of Environmental Health and Pollution Control, Guangdong University of Technology, Guangzhou, China; Institute of Environmental Science, Shanxi Laboratory for Yellow River, Shanxi University, Taiyuan, China.
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Prapamontol T, Norbäck D, Thongjan N, Suwannarin N, Somsunun K, Ponsawansong P, Khuanpan T, Kawichai S, Naksen W. Fractional exhaled nitric oxide (FeNO) in students in Northern Thailand: associations with respiratory symptoms, diagnosed allergy and the home environment. J Asthma 2021; 59:1787-1795. [PMID: 34435554 DOI: 10.1080/02770903.2021.1968424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE There are few studies on fractional exhaled nitric oxide (FeNO) among children in subtropical areas. We studied associations between FeNO and respiratory symptoms, reported diagnosed allergies and indoor and outdoor environmental factors in first grade junior high school students (N = 270) in upper northern Thailand. METHODS Data on demographics, health and home environment were collected by a questionnaire distributed in dry season (February-March 2018). FeNO was measured when the research team visited the school. Daily outdoor pollution data (PM10 and ozone) were collected from the nearest monitoring station 3 days (lag 3) and 7 days (lag 7) before the FeNO measurements. Two-level (student, school) linear mixed models were used to analyze associations, adjusting for gender and family education level. RESULTS In total, 29.6% had elevated FeNO level (>20 ppb) and 7.8% reported any allergy diagnosed by a doctor. Male gender (p = 0.02), diagnosed allergy (p = 0.001), especially to cat (p = 0.001) and house dust mite (HDM) allergies (p = 0.001) were associated with FeNO. Eye symptoms (p = 0.01), rhinitis symptoms (p = 0.03) and dyspnea (p = 0.05) in the last 3 days were associated with FeNO. Household indoor mold (p = 0.03), gas cooking (p = 0.03) and PM10 (lag 3 and lag 7) were negatively (protective) associated with FeNO. CONCLUSIONS Diagnosed allergy, especially to cat and HDM, can be associated with increased FeNO. Indoor mold and gas cooking can be associated with lower FeNO. Ocular, nasal and dyspnea symptoms reported by students in dry season in northern Thailand can be associated with FeNO, a biomarker of Th2 driven airway inflammation.
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Affiliation(s)
- Tippawan Prapamontol
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Dan Norbäck
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand.,Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Nathaporn Thongjan
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Neeranuch Suwannarin
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Kawinwut Somsunun
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | | | - Tosabhorn Khuanpan
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Sawaeng Kawichai
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Warangkana Naksen
- Faculty of Public Health, Chiang Mai University, Chiang Mai, Thailand
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Respiratory Health and Inflammatory Markers-Exposure to Cobalt in the Swedish Hard Metal Industry. J Occup Environ Med 2021; 62:820-829. [PMID: 33009343 DOI: 10.1097/jom.0000000000001952] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To study the relationship between inhalable dust and cobalt, and respiratory symptoms, lung function, exhaled nitric oxide in expired air, and CC16 in the Swedish hard metal industry. METHODS Personal sampling of inhalable dust and cobalt, and medical examination including blood sampling was performed for 72 workers. Exposure-response relationships were determined using logistic, linear, and mixed-model analysis. RESULTS The average inhalable dust and cobalt concentrations were 0.079 and 0.0017 mg/m, respectively. Statistically significant increased serum levels of CC16 were determined when the high and low cumulative exposures for cobalt were compared. Nonsignificant exposure-response relationships were observed between cross-shift inhalable dust or cobalt exposures and asthma, nose dripping, and bronchitis. CONCLUSIONS Our findings suggest an exposure-response relationship between inhalable cumulative cobalt exposure and CC16 levels in blood, which may reflect an injury or a reparation process in the lungs.
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Pignatti P, Visca D, Loukides S, Märtson AG, Alffenaar JWC, Migliori GB, Spanevello A. A snapshot of exhaled nitric oxide and asthma characteristics: experience from high to low income countries. Pulmonology 2020; 28:44-58. [PMID: 33358001 DOI: 10.1016/j.pulmoe.2020.10.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/30/2020] [Accepted: 10/31/2020] [Indexed: 12/30/2022] Open
Abstract
Nitric oxide is a gas produced in the airways of asthmatic subjects and related to T2 inflammation. It can be measured as fractional nitric oxide (FeNO) in the exhaled air and used as a non-invasive, easy to evaluate, rapid marker. It is now widely used in many settings to determine airway inflammation. The aim of this narrative review is to report relationship between FeNO and the physiopathologic characteristics of asthmatic patients. Factors affecting FeNO levels have also been analysed as well as the impact of corticosteroid, target therapies and rehabilitation programs. Considering the availability of the test, spreading this methodology to low income countries has also been considered as a possibility for evaluating airway inflammation and monitoring adherence to inhaled corticosteroid therapy. PubMed data search has been performed restricted to English language papers. Research was limited to studies in adults unless studies in children were the only ones reported for a particular issue. This revision could be useful to summarize the role of FeNO in relation to asthma characteristics and help in the use of FeNO in different clinical settings particularly in low income countries.
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Affiliation(s)
- Patrizia Pignatti
- Allergy and Immunology Unit, Istituti Clinici Scientifici Maugeri IRCCS Pavia, Italy.
| | - Dina Visca
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy and Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como, Italy
| | - Stelios Loukides
- 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | - Anne-Grete Märtson
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Jan-Willem C Alffenaar
- Sydney Pharmacy School, University of Sydney, Sydney, New South Wales, Australia; Westmead Hospital, Sydney, Australia; Marie Bashir Institute of Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia
| | - Giovanni Battista Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - Antonio Spanevello
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy and Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como, Italy
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Norbäck D, Hashim JH, Hashim Z, Cai GH, Sooria V, Ismail SA, Wieslander G. Respiratory symptoms and fractional exhaled nitric oxide (FeNO) among students in Penang, Malaysia in relation to signs of dampness at school and fungal DNA in school dust. THE SCIENCE OF THE TOTAL ENVIRONMENT 2017; 577:148-154. [PMID: 27802882 DOI: 10.1016/j.scitotenv.2016.10.148] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 09/29/2016] [Accepted: 10/19/2016] [Indexed: 06/06/2023]
Abstract
Few health studies exist on dampness and mould in schools in the tropics. We studied associations between fraction of exhaled nitric oxide (FeNO), respiratory symptoms and airway infections among students and dampness and fungal DNA in schools in Malaysia. A total of 368 randomly selected students from 32 classrooms in 8 secondary schools in Penang, Malaysia, participated (58% participation rate). Information on current respiratory symptoms and the home environment was collected by a standardised questionnaire. FeNO was measured by NIOX MINO (50ml/min). The classrooms were inspected and dust was collected by vacuuming on special filters and was analysed for five fungal DNA sequences by quantitative PCR. Linear mixed models and 3-level multiple logistic regression (school, classroom, student) were applied adjusting for demographic data and the home environment. Totally 10.3% reported doctor's diagnosed asthma, 15.1% current wheeze, 12.4% current asthma, 37.3% daytime breathlessness, 10.2% nocturnal breathlessness, 38.9% airway infections and 15.5% had pollen or furry pet allergy. The geometric mean of FeNO was 19.9ppb and 45% had elevated FeNO (>20ppb). Boys had higher levels of FeNO. Chinese had less daytime breathlessness than Malay (OR=0.30: p<0.001). Indoor carbon dioxide levels were low (380-720ppm). Dampness was observed in 18% of the classrooms and was associated with respiratory infections (OR=3.70; 95% CI 1.14-12.1) and FeNO (p=0.04). Aspergillus versicolor DNA was detected in 67% of the classrooms. Higher numbers of Aspergillus versicolor DNA in classroom dust were associated with wheeze (p=0.006), current asthma (p=0.002), respiratory infections (p=0.005) and elevated FeNO levels (p=0.02). In conclusion, respiratory symptoms were common among the students and the high FeNO levels indicate ongoing airway inflammation. Building dampness and the mould Aspergillus versicolor in schools in Malaysia can be risk factors for impaired respiratory health among the students.
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Affiliation(s)
- Dan Norbäck
- Uppsala University, Department of Medical Science, Occupational and Environmental Medicine, University Hospital, 75185 Uppsala, Sweden.
| | - Jamal Hisham Hashim
- United Nations University-International Institute for Global Health, 56000 Kuala Lumpur, Malaysia; Department of Community Health, National University of Malaysia, 56000 Kuala Lumpur, Malaysia
| | - Zailina Hashim
- Department of Environmental and Occupational Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM, Serdang, Selangor, Malaysia
| | - Gui-Hong Cai
- Uppsala University, Department of Medical Science, Occupational and Environmental Medicine, University Hospital, 75185 Uppsala, Sweden
| | - Vinoshini Sooria
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia
| | - Syazwan Aizat Ismail
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia; Environmental Health, Allied Health Science College Sg Buloh, Ministry of Health Malaysia, 47000 Sungai Buloh, Selangor, Malaysia
| | - Gunilla Wieslander
- Uppsala University, Department of Medical Science, Occupational and Environmental Medicine, University Hospital, 75185 Uppsala, Sweden
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