Incense (bakhour) smoke exposure is associated with respiratory symptoms and impaired lung function among adults: A cross-sectional study in Eastern Province of Saudi Arabia

Burning incense (bakhour) is a common cultural practice in Saudi Arabia. However, its health risk assessment has rarely been studied. This study aims to investigate the association between exposure to incense smoke on lung function impairments and respiratory symptoms among young adults in Saudi Arabia. A community-based cross-sectional study was designed with a representative study sample (N = 125) in the Eastern Province of Saudi Arabia. Study participants, exposed group (n = 45), working in bakhour shop and matched control (n = 80), no history of occupational exposure to bakhour smoke, were recruited randomly from the population registry. Socio-demographic and respiratory symptom information were collected through a questionnaire developed based on European Community Respiratory Health Survey II (ECRHS II). Lung function measurements were conducted using a field spirometer. The overall prevalence of wheezing or whistling was 16.8%, with a higher prevalence in exposed group 35.5%. In adjusted models, exposed to incense smoke remained positively associated with respiratory symptoms: wheezing or whistling; breathlessness; chest tightness shortness of breath; woken up by an attack of coughing. Our study suggests that inhaled incense smoke in occupation or at home is a risk factor of lung function impairments among adult population in Saudi Arabia.     

Contribution of incense burning to indoor PM10 and particle-bound polycyclic aromatic hydrocarbons under two ventilation conditions

Burning incense to worship Gods and ancestors is a traditional practice prevalent in Asian societies. This work investigated indoor PM10 concentrations resulting from incense burning in household environments under two conditions: closed and ventilated. The exposure concentrations of particle-bound polycyclic aromatic hydrocarbons (PAHs) were estimated. The factors of potential exposure were also evaluated. Under both conditions, samples were taken at three locations: 0.3, 3.5 and 7 m away from the altar during three periods: incense burning, the first 3 h, and the 4-6 h after cessation of combustion. PAH concentrations of incense smoke were assessed in the laboratory. Personal environment monitors were used as sampling instruments. The results showed a significant contribution of incense burning to indoor PM10 and particulate PAH concentrations. PM10 concentrations near the altar during incense burning were 723 and 178 microg/m3, more than nine and 1.6 times background levels, under closed and ventilated conditions, respectively. Exposure concentrations of particle-bound PAHs were 0.088-0.45 microg/m3 during incense burning. On average, PM10 and associated PAH concentrations were about 371 and 0.23 microg/m3 lower, respectively, in ventilated environments compared with closed conditions. Concentrations were elevated for at least 6 h under closed conditions.     

Impact on lung function among children exposed to home new surface materials: The seven Northeastern Cities Study in China

We conducted a cross‐sectional study to investigate the associations between recent home renovation exposure and lung function in children. We randomly recruited 7326 school children residing in 24 districts from seven cities in northeastern China. We collected information about home renovations from parents using a questionnaire and lung function measurements from children using spirometer recordings gathered by trained professionals and expressed as the forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), maximal mid‐expiratory flow (MMEF), and peak expiratory flow (PEF). We identified higher odds of diminished lung function among these with home renovation in the previous 2 years compared to those without home renovation in the previous 2 years, for FVC (odds ratios [ORs] = 1.84 [95%CI: 1.58, 2.15]; FEV1: ORs = 2.82 [95%CI: 2.36, 3.36]; PEF: ORs = 1.51 [95%CI: 1.24, 1.83]; and MMEF: ORs = 1.90 [95%CI: 1.60, 2.24]). The associations were stronger among children exposed to new polyvinyl chloride (PVC) flooring compared to children exposed to other surface materials. Our results were consistent throughout the analysis of each type of renovation materials. In conclusion, recent home renovation exposure was associated with poor lung function among children. Strategies to protect home owners and their families from respiratory hazards during and after renovation are required.     

Household and behavioral determinants of indoor PM2.5 in a rural solid fuel burning Native American community

Indoor and outdoor concentrations of PM_2.5 were measured for 24 h during heating and non-heating seasons in a rural solid fuel burning Native American community. Household building characteristics were collected during the initial home sampling visit using technician walkthrough questionnaires, and behavioral factors were collected through questionnaires by interviewers. To identify seasonal behavioral factors and household characteristics associated with indoor PM_2.5, data were analyzed separately by heating and non-heating seasons using multivariable regression. Concentrations of PM_2.5 were significantly higher during the heating season (indoor: 36.2 μg/m³; outdoor: 22.1 μg/m³) compared with the non-heating season (indoor: 14.6 μg/m³; outdoor: 9.3 μg/m³). Heating season indoor PM_2.5 was strongly associated with heating fuel type, housing type, indoor pests, use of a climate control unit, number of interior doors, and indoor relative humidity. During the non-heating season, different behavioral and household characteristics were associated with indoor PM_2.5 concentrations (indoor smoking and/or burning incense, opening doors and windows, area of surrounding environment, building size and height, and outdoor PM_2.5). Homes heated with coal and/or wood, or a combination of coal and/or wood with electricity and/or natural gas had elevated indoor PM_2.5 concentrations that exceeded both the EPA ambient standard (35 μg/m³) and the WHO guideline (25 μg/m³).     

Household biomass fuel use is associated with chronic childhood malnutrition: Result from a nationwide cross-sectional survey in Bangladesh

Despite significant investment, childhood malnutrition continues to be a significant public health problem especially in least developed countries. The aim of this study was to find association between household biomass fuel (BMF) use and childhood malnutrition in Bangladesh using data from Demographic and Health Survey 2011. We included a total 6891 children under 5 years of age in the analysis. The prevalence of wasting, underweight, and stunting from BMF using household was 16.1% (n = 997; 95%CI, 15.1–17.3), 39.0% (n = 2399; 95%CI, 37.1–40.9), and 43.3% (n = 2620; 95%CI, 41.6–45.1), respectively. Underweight and stunting were significantly higher among children from households using BMF compared with the children from CF using households (underweight, biomass vs clean fuel: 39.0% vs. 23.5%, p < 0.001; stunting, biomass vs clean fuel: 43.3 vs. 31.5%, p < 0.001). The use of BMF in the household was significantly associated with underweight (OR = 1.38; 95%CI: 1.10–1.73) and stunting (OR = 1.58; 95%CI: 1.18–1.98) among children <5 years of age after adjusting possible confounders in mixed effect logistic regression analysis. This study found a significant association between chronic childhood malnutrition and household BMF use which is indicating possible alternative risk factor for malnutrition. Further prospective research is required to explore the mechanism of how BMF use results in chronic malnutrition.     

Asthma‐related outcomes associated with indoor air pollutants among schoolchildren from four informal settlements in two municipalities in the Western Cape Province of South Africa

The health impact of indoor air pollution in informal settlement households has not been extensively studied in South Africa. This cross‐sectional study investigated the association between asthma and common indoor exposures among schoolchildren from four informal settlements located in two municipalities in the Western Cape Province. A total of 590 children, aged 9‐11 years, were recruited. The International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was administered to caregivers. Pulmonary function assessment included spirometry and fractional exhaled nitric oxide (FeNO). Phadiatop test for atopy was done. The prevalence of doctor‐diagnosed asthma was 3.4% (n = 20) among whom only 50% were on treatment. The prevalence of current wheeze was 12.9%, and 17.6% had airway obstruction (FEV₁ < lower limit of normal), while 10.2% had airway inflammation (FeNO > 35 ppb). In adjusted logistic regression models, dampness, visible mold growth, paraffin use for cooking, and passive smoking were associated with a twofold to threefold increased risk in upper and lower airway outcomes. The strongest association was that of visible mold growth with rhinitis (adjusted odds ratio—aOR 3.37, 95% CI: 1.69‐6.71). Thus, there is a need for improved diagnosis of childhood asthma and Indoor Air Quality in informal settlement households.     

The mycobiomes and bacteriomes of sputum,saliva, and home dust

Respiratory microbiome is an understudied area of research compared to other microbiomes of the human body. The respiratory tract is exposed to an array of environmental pollutants, including microbes. Yet, we know very little about the relationship between environmental and respiratory microbiome. The primary aim of our study was to compare the mycobiomes and bacteriomes between three sample types from the same participants, including home dust, saliva, and sputum. Samples were collected from 40 adolescents in a longitudinal cohort. We analyzed the samples using 16s bacterial rDNA and ITS fungal rDNA gene sequencing, as well as quantitative PCR with universal fungal and bacterial primers. Results showed that home dust had the greatest alpha diversity between the three sample types for both bacteria and fungi. Dust had the highest total fungal load and the lowest total bacterial load. Sputum had greater bacterial diversity than saliva, but saliva had greater fungal diversity than sputum. The distribution of major bacterial phyla differed between all sample types. However, the distribution of major fungal classes differed only between sputum and saliva. Future research should examine the biological significance of the taxa found in each sample type based on microbial ecology and associations with health effects.     

再谈风机叶片等复合材料固体废物焚烧法处置存在的问题

对复合材料固废回收及综合利用发展产业发展状况进行了介绍,在数据支撑及国家部门有关政策要求的基础上,指出复合材料现有处理技术及存在的问题.在结合国家能源结构战略调整的大背景下,结合相关企业实际经验,得出了有效可行的解决办法.     

Indoor fine particulate matter and demographic,household, and wood stove characteristics among rural US homes heated with wood fuel

Household heating using wood stoves is common practice in many rural areas of the United States (US) and can lead to elevated concentrations of indoor fine particulate matter (PM_2.5). We collected 6-day measures of indoor PM_2.5 during the winter and evaluated household and stove-use characteristics in homes at three rural and diverse study sites. The median indoor PM_2.5 concentration across all homes was 19 µg/m³, with higher concentrations in Alaska (median = 30, minimum = 4, maximum = 200, n = 10) and Navajo Nation homes (median = 29, minimum = 3, maximum = 105, n = 23) compared with Montana homes (median = 16, minimum = 2, maximum = 139, n = 59). Households that had not cleaned the chimney within the past year had 65% higher geometric mean PM_2.5 compared to those with chimney cleaned within 6 months (95% confidence interval [CI]: −1, 170). Based on a novel wood stove grading method, homes with low-quality and medium-quality stoves had substantially higher PM_2.5 compared to homes with higher-quality stoves (186% higher [95% CI: 32, 519] and 161% higher; [95% CI:27, 434], respectively). Our findings highlight the need for, and complex nature of, regionally appropriate interventions to reduce indoor air pollution in rural wood-burning regions. Higher-quality stoves and behavioral practices such as regular chimney cleaning may help improve indoor air quality in such homes.     

Different health effects of indoor‐ and outdoor‐originated PM2.5 on cardiopulmonary function in COPD patients and healthy elderly adults

Numerous research has explored the associations of outdoor or indoor fine particulate matter (PM_2.5) and health effects; however, few studies compared the effects of indoor PM_2.5 originated from outdoor (PM_2.5,os) and indoor sources (PM_2.5,is). To assess the associations of PM_2.5,os and PM_2.5,is with cardiopulmonary function in patients with chronic obstructive pulmonary disease (COPD) and healthy elderly adults, blood pressure (BP) and pulmonary function were repeatedly examined in 43 COPD patients and their 32 healthy spouses in Beijing, China. Iron was used as tracer element to separate PM_2.5,os and PM_2.5,is. Mixed‐effects models were applied to assess the associations of PM_2.5,os or PM_2.5,is and health effects after controlling for potential confounders. There was a reduction in forced expiratory volume in first second (FEV₁) in COPD patients associated with PM_2.5,is during the heating season. PM_2.5,os was positively associated with diastolic BP (DBP) in healthy elderly adults during the heating season. There was a reduction in peak expiratory flow (PEF) in healthy elderly adults associated with PM_2.5,os during the non‐heating season. Exposure to indoor‐ and outdoor‐originated PM_2.5 had different health effects on cardiopulmonary function in different populations. The results provide supporting evidence for improving indoor air quality to promote public health among susceptible population.     

Housing characteristics and indoor air quality in households of Alaska Native children with chronic lung conditions

Alaska Native children experience high rates of respiratory infections and conditions. Household crowding, indoor smoke, lack of piped water, and poverty have been associated with respiratory infections. We describe the baseline household characteristics of children with severe or chronic lung disease participating in a 2012–2015 indoor air study. We monitored indoor PM2.5, CO₂, relative humidity %, temperature, and VOCs and interviewed caregivers about children's respiratory symptoms. We evaluated the association between reported children's respiratory symptoms and indoor air quality indicators using multiple logistic regression analysis. Compared with general US households, study households were more likely overcrowded 73% (62%–82%) vs 3.2% (3.1%–3.3%); had higher woodstove use as primary heat source 16% (9%–25%) vs 2.1% (2.0%–2.2%); and higher proportion of children in a household with a smoker 49% (38%–60%) vs 26.2% (25.5%–26.8%). Median PM2.5 was 33 μg/m³. Median CO₂ was 1401 ppm. VOCs were detectable in all homes. VOCs, smoker, primary wood heat, and PM2.5>25 μg/m³ were associated with higher risk for cough between colds; VOCs were associated with higher risk for wheeze between colds and asthma diagnosis. High indoor air pollutant levels were associated with respiratory symptoms in household children, likely related to overcrowding, poor ventilation, woodstove use, and tobacco smoke.     

Dust exposure and lung function of workers in the brick and clay pottery factories in the Northeast of Thailand

This study aimed to determine the particulate matter concentrations (PM10) in workplace air and personal dust, and their effects on the respiratory health of exposed workers. The lung function of 449 exposed workers was examined. The concentration of PM10 in workplace air and personal dust exposure was measured. Spirometry was used to evaluate the lung function capacity included forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), forced expiratory volume ratio (FEV%) and peak expiratory flow rate (PEF). The forced expiratory flow at 25% to 75% of the FVC (FEF 25-75%) was determined. The PM10 concentration in workplace air (6 study sites) and personal dust (4 study sites) exceeded the standard (REL) of 0.12 mg/m3. The results of this study showed a decrease in the mean values and percent predicted value of FVC, FEV1, FEV1%, PEF and FEF 25-75%. The lung capacity of participants revealed that 24.50%, 4.45% and 7.13% had mildly, moderately restrictive and small airway disease. The respiratory symptoms were dyspnoea (22.49%), wheezing (10.69%), chest pain (10.69%) and chronic cough (2.90%). Factors influencing lung capacity included mask usage (Adj.OR: 0.44 CI: 0.25-0.79 p-value: 0.006) and chest pain (Adj.OR: 2.68 CI: 1.14-6.30 p-value: 0.024).     

Humidifier disinfectant and use characteristics associated with lung injury in Korea

Since around the year 2000, hundreds of people in Korea have developed humidifier disinfectant‐associated lung injury (HDLI). We collected all HD exposure‐related information from the field investigations into the locations in which the 1199 registered patients had used HD. Among the people who registered, 38% (1st round = 214, 2nd = 73, 3rd = 166) were confirmed as HDLI patients. Children aged under eight years old made up the highest proportion of HDLI cases (N = 279, 62%), followed by pregnant women (N = 31, 7%). One hundred thirty‐three (29%) of the confirmed HDLI patients died. Fifty‐seven percent of HDLI patients (N = 259) developed HDLI after <1 year of HD use. The number of HDLI patients who used only the Oxy Saksak HD brand was found to be 176 (39%), followed by the brands Cefu (N = 27, 6%) and Aekyung (N = 22, 5%). HD products containing only polyhexamethylene guanidine phosphate (PHMG‐P) were the most frequently used among HDLI patients (N = 234, 52%), followed by oligo (2‐(2‐ethoxy)ethoxyethyl) guanidinium (PGH) (N = 27, 6%) and a mixture of chloromethylisothiazolinone (CMIT) and methylisothiazolinone (MIT) (N = 26, 6%). The average PHMG‐P inhalation level estimated from the patient group classified as suffering lung injury definitely associated with HD use was 145.1 μg/m³ (N = 91, SD = 395.1 μg/m³), higher than levels estimated from both the probable and possible HDLI patient groups. In conclusion, HD exposure‐related variables, including type of HD brand and estimated inhalation HD level, were associated with the risk of HDLI.     

Pre‐natal and post‐natal exposure to pet ownership and lung function in children: The Seven Northeastern Cities Study

To evaluate the association between pre‐natal and post‐natal exposure to pet ownership and lung function in children, a cross‐sectional study named Seven Northeastern Cities (SNEC) study was conducted. In this study, children's lung function including the forced expiratory volume in 1 second (FEV₁), forced vital capacity (FVC), maximal mid‐expiratory flow (MMEF), and peak expiratory flow (PEF) were measured by spirometers, and pet ownership situations were collected by questionnaire. Analyzed by multiple logistic regression and generalized linear modeling, we found that for all subjects, pet exposure in the first 2 years of life was significantly associated with lung function impairment of FVC<85% predicted (adjusted odds ratio [aOR]=1.28; 95% confidence interval [CI]: 1.01, 1.63). For current pet exposure, the increased odds of lung function impairment ranged from 35% (aOR=1.35; 95%CI: 1.12, 1.62) for FVC<85% predicted to 57% (aOR=1.57; 95%CI: 1.29, 1.93) for FEV₁<85% predicted. The in utero exposure was not related to lung function impairment. Compared with other pets, higher odds were observed among children with dogs. When stratified by gender, girls with current pet exposure were more likely to have lung function impairment than boys. It implies self‐reported exposures to pets were negatively associated with lung function among the children under study.     

Assessment of environmental tobacco smoke exposure: urinary cotinine concentrations in children are strongly associated with the house dust concentrations of nicotine at home

In the present study the possibility of using nicotine in house dust as an index of environmental tobacco smoke (ETS) exposure was evaluated in an environmental investigation of 23 children with asthma. A standardized procedure for house dust sampling of nicotine with a filter holder connected to a vacuum cleaner, for a defined time and area was developed (F-nicotine). Also, house dust sampling was carried out from the vacuum cleaner bags of the homes (VC-nicotine). There was a larger variation in VC-nicotine (13-655, median 66 microg/g) compared with F-nicotine (15-393 median 156 microg/g). There were statistically significant associations between an inquiry data based ETS exposure index on the one hand, and urinary cotinine concentrations in children (U-cotinine), F-nicotine and VC-nicotine of their homes, on the other. The strong correlation between U-cotinine and F-nicotine (rs = 0.93; P < 0.0001) indicates that the new standardized house dust sampling method should be useful in ETS exposure assessment. However, further validation by a larger sample size with repeated measurements in the same homes is needed.     

Effects of cigarette smoking and biomass fuel on lung function and respiratory symptoms in middle-aged adults and the elderly in Guangdong province,China: A cross-sectional study

We sought to investigate the association between active cigarette smoking (ex- and current smokers) with or without exposure to biomass fuels and respiratory symptoms/lung function in middle-aged adults and the elderly. In the chronic obstructive pulmonary disease surveillance conducted in six cities of Guangdong province, China, we surveyed 1986 residents aged 40-93 years. We recorded respiratory symptoms, smoking status, use of biomass fuel, and other covariates by using a structured questionnaire. All models were adjusted for second-hand smoking. Active smoking with or without exposure to biomass fuels was significantly associated with wheezing, chronic cough, and phlegm (all P < .05). Active smoking alone with or without exposure to biomass fuels was associated with 2.5% and 0.6% reduction in the mean forced vital capacity predicted, 6.8% and 4.2% reduction in the mean forced expiratory volume in one second predicted, and 9.0% and 4.7% reduction in the mean maximal mid-expiratory flow predicted compared with the exposure to neither smoking nor biomass fuels, respectively. However, exposure to biomass fuel alone was associated with neither greater lung function impairment nor respiratory symptoms except for chronic cough. Efforts should be made to protect home owners and their family from adverse effects of indoor air pollution.     

Association of toxic and essential metals with atopy markers and ventilatory lung function in women and men

The association of age, smoking, alcohol, superoxide dismutase (SOD), glutathione peroxidase (GPx), blood lead (BPb) and cadmium (BCd) levels, and serum levels of copper (SCu), zinc (SZn) and selenium (SSe) with atopic status and ventilatory function was examined in the groups of 166 women and 50 men with no occupational exposure to metals or other xenobiotics. Markers of atopy included serum total IgE, skin prick test (SPT) to common inhalatory allergens, non-specific nasal reactivity (NNR) and non-specific bronchial reactivity (NBR). Parameters of ventilatory function included forced vital capacity (FVC) and forced expiratory volume in the first second (FEV(1)). Significantly higher BPb, SZn, IgE and prevalence of positive SPT, and lower SCu and NNR was found in men than in women. Fifteen women taking female sex hormones (HT) had significantly higher SCu than women without HT. Regression models showed significant inverse associations between IgE and SCu (P=0.021) and NNR and SCu (P=0.044) in women. When excluding women with HT, the association of SCu and total IgE became of borderline significance (P=0.051), association between SCu and NNR disappeared, and significant positive association between total IgE and BPb emerged (P=0.046). In men, significant inverse association was found between positive SPT and SSe, and between NBR and SSe. A decrease in FVC% and FEV(1)% was associated with an increase in smoking intensity (P<0.001) and a decrease in SZn (P=0.043 and P=0.053, respectively). These results were observed at the levels of the metals comparable to those in general populations worldwide. The observed differences between men and women may partly be explained by different levels of relevant toxic and essential metals, and their combination. The role of female HT in associations of atopy markers and SCu should be further investigated.