Household incense burning and children's respiratory health: A cohort study in Hong Kong

Zhang, Zilong; Tan, Lixing; Huss, Anke; Guo, Cui; Brook, Jeffrey R.; Tse, Lap Ah; Lao, Xiang Qian

doi:10.1002/ppul.24251

Cited by 20 publications

(10 citation statements)

References 23 publications

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“…Our finding is unique in that aspect and suggested that exposed to incense smoke increased lung impairment (AOR: 1.72; 95% CI: 1.21–3.85). The association is consistent with previous studies 6,8 . In Taiwan, a study reported lower values of FVC and FEV1 among adolescents with daily exposure to incense burning in home 6 .…”

Section: Discussionsupporting

confidence: 91%

“…In Taiwan, a study reported lower values of FVC and FEV1 among adolescents with daily exposure to incense burning in home 6 . In Hong Kong, incense burning was found to be associated with reduced peak expiratory flow (PEF) among children 8 . There are several studies that found association between air pollution exposures and lung function impairments among adult population.…”

Section: Discussionmentioning

confidence: 99%

“…Respiratory diseases, including chronic obstructive pulmonary disease (COPD), represent a significant burden on public health 1,2 . Incense (bakhour) burning is an ancient practice and is common to many Asian and Arabian communities 3‐9 . A study in China highlighted that burning incense can increase asthma, rhinitis, wheeze, and eczema in preschool children 9 .…”

Section: Introductionmentioning

confidence: 99%

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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

et al. 2021

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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.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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

et al. 2021

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“…One plausible explanation was that respiratory problems were more prevalent in boys than in girls at the baseline. 55 Consistently, previous cross-sectional population-based studies among children also indicated that incense burning was associated to the increased risk of various respiratory diseases and symptoms such as asthma, cough, and wheeze in an exposure-response manner. 56–58 On the other hand, the opposite finding, that is, there was no significant relationship between incense burning with prevalence of respiratory problems including chronic cough, chronic sputum, chronic bronchitis, runny nose, wheezing, asthma, allergic rhinitis or pneumonia was reported in a cross-sectional investigation among 346 primary school children in Hong Kong.…”

Section: Evidence-based Associations Between Incense Burning and Health Effectssupporting

confidence: 71%

The Adverse Impact of Incense Smoke on Human Health: From Mechanisms to Implications

Lee¹,

Vo²,

Wee³

et al. 2021

JIR

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Incense burning is a very popular activity in daily life among many parts all over the world. A growing body of both epidemiological and experimental evidences has reported the negative effects of incense use on human well-being, posing a potential threat at public significance. This work is a comprehensive review that covers the latest findings regarding the adverse impact of incense smoke on our health, providing a panoramic visualization ranging from mechanisms to implications. The toxicities of incense smoke come directly from its harmful constituents and deposition capacity in the body. Besides, reactive oxygen species-driven oxidative stress and associated inflammation seem to be plausible underlying mechanisms, eliciting various unfavorable responses. Although our current knowledge remains many gaps, this issue still has some important implications.

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“…The original Kotz model is largely driven by age (17), but in the EHS cohort, age did not predict COPD in men or women (Table S1). Ex-or current smoking did not predict COPD as strongly in the EHS cohort as in the original Kotz model, possibly due to the small number of cigarettes smoked per day in Hong Kong and the existence of other context-specific causes of COPD (Table 1), such as incense burning (64,65). As previously, low BMI, low socioeconomic position, and ever drinking all predicted COPD (8,32,(37)(38)(39)(40)(41)(42)(43)(44)66,67).…”

Section: Risk Predictorsmentioning

confidence: 65%

Development and validation of the EHS-COPD model to predict sex-specific risk of chronic obstructive pulmonary disease (COPD) in older Chinese adults: Hong Kong’s Elderly Health Service Cohort

Yang¹,

Schooling²,

Lee³

et al. 2022

Ann Transl Med

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Background: No screening program is recommended for chronic obstructive pulmonary disease (COPD) in adults based on current clinical practice guidelines. Risk prediction models for COPD developed in Western settings may not be directly applicable to older Chinese adults. To evaluate the performance of an existing risk prediction model for COPD developed in a Western setting in Chinese adults and investigate whether a new risk prediction model performs better in predicting 5-year risk of COPD (EHS-COPD).Methods: This study is based on 135,822 participants aged 65+ years from Hong Kong's Elderly Health Service (EHS) cohort. We assessed the performance of an existing risk prediction model in the entire cohort, and in a random sub-sample of 91,133 participants, we recalibrated the existing model and derived a new model using extended Cox proportional hazards regression. Candidate risk predictors from the literature and the EHS cohort were considered for inclusion. Risk prediction performance, discrimination, and calibration of the newly derived models were assessed in the remaining 44,689 participants. Results:The existing risk prediction model overestimated the 5-year risk of COPD in older Chinese adults (65+ years); after recalibration, it still overestimated the 5-year risk of COPD for both men and women.The new EHS-COPD risk prediction model, including time-varying factors (i.e., age and smoking status) and time-invariant factors (i.e., education level, public assistance, alcohol use, body mass index, physical activity, existing hypertension, recent falls, cognitive function, and self-rated health status), had an improved performance. For men, EHS-COPD explained 19.5% of COPD risk, the D statistic was 23.1, and Harrell's C statistic was 0.93. The corresponding values for women were 8.5%, 21.1, and 0.93. Conclusions:The existing COPD risk prediction model overpredicted COPD risk in older Chinese and could not be recalibrated to predict well. A revised prediction model using time-invariant and time-varying factors provides a better tool for identifying older Chinese adults at high risk of developing COPD.

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Household incense burning and children's respiratory health: A cohort study in Hong Kong

Cited by 20 publications

References 23 publications

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

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

The Adverse Impact of Incense Smoke on Human Health: From Mechanisms to Implications

Development and validation of the EHS-COPD model to predict sex-specific risk of chronic obstructive pulmonary disease (COPD) in older Chinese adults: Hong Kong’s Elderly Health Service Cohort

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