Dual exposure to smoking and household air pollution is associated with an increased risk of severe asthma in adults in Brazil

Abstract

BackgroundThe relationship between smoking, household pollution, dual exposure and severity of asthma in adults has not been sufficiently studied. We examined and compared the effects of cigarette smoking, domestic wood burning pollution and dual exposure (tobacco and wood burning) upon asthma severity in adults.MethodsThis was a cross-sectional study performed with 452 individuals with mild to moderate asthma and 544 patients with severe asthma (previously untreated). Smoking and exposure to wood smoke were identified and quantified through questionnaires to evaluate current and/or previous exposure; objective determination of cigarette exposure was obtained through the measurement of urinary cotinine. Asthma control was evaluated through Asthma Control Questionnaire; and severity was classified according to the Global Initiative for Asthma criteria. Subjects were grouped according to exposure type into 4 groups: smokers, household pollution, dual-exposure and no-exposure. Chi square, Mann–Whitney, and Kruskal–Wallis tests were used for comparisons between groups.ResultsOut of 996 included individuals, 78 (7.8%) were exposed to cigarette smoking alone, 358 (35.9%) to household pollution alone, 155 (15.6%) to the two exposures combined and 405 (40.7%) were not exposed. Compared to unexposed individuals, exposure to household pollution resulted in poorer asthma control, higher proportion of severe asthma, and worse indicators of lung function. The double-exposed individuals were worse off in all the evaluated parameters, and they were significantly worse than subjects with single exposure to household air pollution in relation to asthma severity and lung function. These subjects were predominantly females, older, with longer residence time in rural areas, lower income and lower schooling levels. Multivariate analysis showed that exposure to household pollution and double exposure were predictive factors associated with lack of control and increased severity of asthma.ConclusionsExposure to household pollution is associated with poorer control, greater severity, and poorer pulmonary function; double-exposed individuals have a greater risk of severe asthma and decreased lung function than those exposed only to household pollution.

Asthma similarities across ProAR (Brazil) and U-BIOPRED (Europe) adult cohorts of contrasting locations, ethnicity and socioeconomic status

“…The lower FEV 1 /FVC among the Europeans likely reflects more severe airflow limitation, which is congruent with other observations from the U-BIOPRED groups. Among the Brazilians, 64% of those with SA and 36% with MMA have been exposed to household pollution of wood burning for cooking, which is a problem of larger dimension than tobacco smoking in this sample and has just been recently reported [18]. Within the SA patients, 11% U-BIOPRED and 24% ProAR show signs of moderate to severe depression compared to 0% U-BIOPRED and 16% ProAR MMA samples.…”

Smoking status and second-hand smoke biomarkers in COPD, asthma and healthy controls

“…Papers published before 2000, not in English, or reporting only data on nonadult subjects or only data on pregnant women were excluded from the analysis. 14 papers addressing the topic accordingly to the inclusion criteria were included in our final analysis [2][3][4][5][6][7][8][9][10][11][12][13][14][15]. For each article, we extracted information from the main texts of those reporting data in the abstracts on the cut-offs of at least one of the investigated biomarkers in at least one of the populations of interest.…”

“…A higher urinary cotinine level was associated with greater COPD severity, worsened physical health status and poorer disease-specific quality of life in another study [3]. Asthma patients FERNANDES et al [9] assessed a cut-off value for urinary cotinine that was normalised with serum creatinine, in order to take into consideration the influence of renal function on cotinine urinary concentration. The value of 197 µg•g −1 confirmed the smoking status previously declared by the patients.…”

Highlights and recent developments in airway diseases in EAACI journals (2018)

“…Among these factors, dual exposure led to the poorest asthma control and greatest asthma severity. In addition, indoor wood burning led to more detrimental respiratory problems compared to cigarette smoke . Given the importance of airborne allergens in the home, a pilot study was undertaken to quantify the indoor concentration of allergens.…”

“…In addition, indoor wood burning led to more detrimental respiratory problems compared to cigarette smoke. 70 Given the importance of airborne allergens in the home, a pilot study was undertaken to quantify the indoor concentration of allergens. The sample was collected using commercially available low volume air sampling pumps and DUSTREAT ® dust samplers and quantified at a very low detection limit using a MARIA ® immunoassay.…”