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Indoor air pollution exposure effects on lung and cardiovascular health in the High Himalayas, Nepal: An observational study

Published:October 31, 2018DOI:https://doi.org/10.1016/j.ejim.2018.10.023

      Highlights

      • Indoor air pollution (IAP) is a cause of morbidity and mortality in the population of the poorest countries.
      • The effects of IAP on cardiovascular and pulmonary diseases 'is not well known.
      • Poor indoor air quality induces an impairment of airways function and cardiovascular damage.
      • Long term IAP exposure is associated to substantial burden of COPD and of cardiovascular dysfunction.
      • The use of clean cook stoves and fuels could dramatically reduce IAP and the associated adverse health effects.

      Abstract

      Background

      Exposure to indoor biomass fuel smoke is associated with increased morbidity and mortality. The aim of this study is to evaluate the association between exposure to indoor biomass burning and early pulmonary and cardiovascular damage.

      Methods

      The indoor levels of particulate matter (PM) [PM10, PM2.5] and black carbon (BC) were monitored in 32 houses in a Himalayan village. Seventy-eight subjects were submitted to spirometry and cardiovascular evaluation [carotid to femoral pulse wave velocity (PWV) and echocardiography].

      Results

      Peak indoor BC concentration up to 100 μg m−3 and PM10 - PM2.5 up to 1945–592 μg m−3 were measured. We found a non-reversible bronchial obstruction in 18% of subjects ≥40 yr; mean forced expiratory flow between 25% and 75% of the forced vital capacity (FEF25–75) <80% in 54% of subjects, suggestive of early respiratory impairment, significantly and inversely related to age. Average BC was correlated with right ventricular-right atrium gradient (R = 0.449,p = .002), total peripheral resistances (TPR) (R = 0.313,p = .029) and PWV (R = 0.589,p < .0001) especially in subjects >30 yr. In multiple variable analysis, BC remained an independent predictor of PWV (β = 0.556,p = .001), and TPR (β = 0.366;p = .018).

      Conclusions

      Indoor pollution exposure is associated to early pulmonary and cardiovascular damages, more evident for longer duration and higher intensity exposure.

      Keywords

      Abbreviation:

      BC (black carbon), BMI (body mass index), COPD (chronic obstructive pulmonary disease), DBP (diastolic blood pressure), FVC (forced vital capacity), FEF25–75 (forced vital capacity), FEV1 (forced expiratory volume in one second), FRS (Framingham risk score), IAP (indoor air pollution), PM (particulate matter), PVR (Pulmonary vascular resistance), PWV (carotid to femoral pulse wave velocity), RV-RA gradient (pressure gradient between the right ventricle and the right atrium), SBP (systolic blood pressure), sPAP (systolic pulmonary artery pressure), TPR (total peripheral resistances), WHO (World Health Organization)
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      References

        • WHO Burning Opportunity: Clean Household Energy for Health
        Sustainable development, and wellbeing of women and children.
        (Accessed March 1 2018)
        • Brook R.D.
        • Rajagopalan S.
        • Pope C.A.
        • et al.
        Particulate matter air pollution and cardiovascular disease: an update to the scientific statement from the American Heart Association.
        Circulation. 2010; 121: 2331-2378
        • Pope C.A.
        • Dockery D.W.
        Health effects of fine particulate air pollution: lines that connect.
        J Air Waste Manag. 2006; 56: 709-742
        • Gordon S.B.
        • Bruce N.G.
        • Grigg J.
        • et al.
        Respiratory risks from household air pollution in low and middle income countries.
        Lancet Respir Med. 2014; 2: 823-860
        • Janssen N.A.H.
        • Gerlofs-Nijland M.E.
        • Lanki T.
        • et al.
        Health effects of black carbon.
        WHO Reports, 2012 (Accessed March 1 2018)
        • Bruce N.
        • Smith K.R.
        WHO indoor air quality guidelines: household fuel combustion.
        (Accessed March 1 2018)
        • Mortimer K.
        • Gordon S.B.
        • Jindal S.K.
        • et al.
        Household air pollution is a major avoidable risk factor for cardiorespiratory disease.
        Chest. 2012; 142: 1308-1315
        • Kurmi O.P.
        • Ayres J.G.
        The non-occupational environment and the lung: opportunities for intervention.
        Chron Respir Dis. 2007; 4: 227-236
        • Riley L.
        • Cowan M.
        Non communicable diseases progress monitor.
        World Health Organization, 2015 (. ISBN: 978 92 4 150945 9)
        • Bonasoni P.
        • Laj P.
        • Marinoni A.
        • et al.
        Jatmospheric brown clouds in the himalayas: First two years of continuous observations at the Nepal Climate observatory-pyramid (5079 m) Atmos.
        Chem Phys. 2010; 10: 7515-7531
        • Subedi Y.P.
        • Marais D.
        • Newlands D.
        Where is Nepal in the nutrition transition?.
        Asia Pac J Clin Nutr. 2017 Mar; 26: 358-367
        • Lhamo S.Y.
        • Supamai S.
        • Virasakdi C.
        Impaired glucose regulation in a Sherpa indigenous population living in the Everest region of Nepal and in Kathmandu Valley.
        High Alt Med Biol. 2008 Fall; 9: 217-222
        • Duo E.
        • Bruno R.M.
        • Basnyat B.
        • et al.
        Indoor pollution in high-altitude dwellings: An assessment of affecting factors across four Sherpa villages in the Khumbu region, Nepal.
        Indoor Build Environ. 2016; 0/(0): 1-10
        • Levey A.S.
        • Bosch J.P.
        • Lewis J.B.
        • et al.
        A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of diet in renal disease study group.
        Ann Intern Med. 1999; 130: 461-470
        • Miller M.R.
        • Hankinson J.
        • Brusasco V.
        • et al.
        Standardisation of spirometry.
        Eur Respir J. 2005; 26: 319-338
        • Quanjer P.H.
        • Stanojevic S.
        • Cole T.J.
        • et al.
        Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations.
        Eur Respir J. 2012; 40: 1324-1343
        • Gibson G.J.
        Standardized lung function testing.
        Eur Respir J. 1993; 16: 25-27
        • D'Agostino R.B.
        • Vasan R.S.
        • Pencina M.J.
        • et al.
        General cardiovascular risk profile for use in primary care: The framingham heart study.
        Circulation. 2008; 117: 743-753
        • Laurent S.
        • Cockcroft J.
        • Van Bortel L.
        • et al.
        2006 Expert consensus document on arterial stiffness: Methodological issues and clinical applications.
        Eur Heart J. 2006; 27: 2588-2605
        • Lang R.M.
        • Badano L.P.
        • Mor-Avi V.
        • et al.
        Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American society of Echocardiography and the European association of Cardiovascular imaging.
        J Am Soc Echocardiogr. 2015; 28 (e14): 1-39
        • Quinones M.A.
        • Otto C.M.
        • Stoddard M.
        • et al.
        Recommendations for quantification of Doppler echocardiography: A report from the Doppler quantification task force of the nomenclature and standards committee of the American society of echocardiography.
        J Am Soc Echocardiogr. 2002; 15: 167-184
        • Nagueh S.F.
        • Middleton K.J.
        • Kopelen H.A.
        • et al.
        Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures.
        J Am Coll Cardiol. 1997; 30: 1527-1533
        • Rudski L.G.
        • Lai W.W.
        • Afilalo J.
        • et al.
        Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American society of echocardiography endorsed by the European association of echocardiography, a registered branch of the European society of cardiology, and the Canadian society of echocardiography.
        J Am Soc Echocardiogr. 2010; 23: 685-713
        • Argiento P.
        • Vanderpool R.R.
        • Mule M.
        • et al.
        Exercise stress echocardiography of the pulmonary circulation: Limits of normal and gender differences.
        Chest. 2012 Nov; 142: 1158-1165
        • Obeidat M.
        • Hao K.
        • Bossé Y.
        • et al.
        Molecular mechanisms underlying variations in lung function: a systems genetics analysis.
        Lancet Respir Med. 2015; 3: 782-795
        • Carter E.
        • Archer-Nicholls S.
        • Ni K.
        • et al.
        Seasonal and diurnal air pollution from residential cooking and space heating in the Eastern Tibetan Plateau.
        Environ Sci Technol. 2016; 50: 8353-8361
        • Clarck M.L.
        • Peel J.L.
        • Balakrishnan K.
        • et al.
        Health and household air pollution from solid fuel use: The need for improved exposure assessment.
        Environ Health Perspect. 2013; 121: 1120-1128
        • Kar A.
        • Rehman I.H.
        • Burney J.
        • Puppala S.P.
        Real-time assessment of Black Carbon pollution in Indian households due to traditional and improved biomass cookstoves.
        Environ Sci Technol. 2012; 46: 2993-3000
        • Pellegrino R.
        • Viegi G.
        • Brusasco V.
        • et al.
        Interpretative strategies for lung function tests.
        Eur Respir J. 2005; 26: 948-968
        • Woolf C.R.
        Clinical findings, sputum examinations, and pulmonary function tests related to the smoking habit of 500 women.
        Chest. 1974; 66: 652-659
        • White J.R.
        • Froeb H.F.
        Small-airways dysfunction in non-smokers chronically exposed to tobacco smoke.
        N Engl J Med. 1980; 27: 720-723
        • De Jong D.
        • Boezen H.M.
        • Kromhout H.
        • et al.
        Occupational exposure to vapors, gases, dusts, and fumes is Associated with small airways obstruction.
        Am J Respir Crit Care Med. 2014; 2014: 487-490
        • Silva R.
        • Oyarzún M.
        • Olloquequi J.
        Pathogenic mechanisms in chronic obstructive pulmonary disease due to biomass smoke exposure.
        Arch Bronconeumol. 2015; 51: 285-292
        • Kurmi O.P.
        • Semple S.
        • Simkhada P.
        • et al.
        COPD and chronic bronchitis risk of indoor air pollution from solid fuel: A systematic review and meta-analysis.
        Thorax. 2010; 65: 221-228
        • Zeng G.
        • Sun B.
        • Zhong N.
        Non-smoking-related chronic obstructive pulmonary disease: A neglected entity.
        Respirology. 2012; 17: 908-912
        • Peña V.S.
        • Miravitlles M.
        • Gabriel R.
        • et al.
        Geographic variations in prevalence and under diagnosis of COPD: Results of the IBERPOC multicentre epidemiological study.
        Chest. 2000; 118: 981-989
        • Epstein M.B.
        • Bates M.N.
        • Arora N.K.
        • et al.
        Household fuels, low birth weight, and neonatal death in India: The separate impacts of biomass, kerosene, and coal.
        Int J Hyg Environ Health. 2013; 216: 523-532
        • Atsou K.
        • Chouaid C.
        • Hejblum G.
        Variability of the chronic obstructive pulmonary disease key epidemiological data in Europe: Systematic review.
        BMC Med. 2011; 9: 7
        • Bischoff E.W.
        • Schermer T.R.
        • Bor H.
        • et al.
        Trends in COPD prevalence and exacerbation rates in Dutch primary care.
        Br J Gen Pract. 2009; 59: 927-933
        • Rycroft C.E.
        • Heyes A.
        • Lanza L.
        • Becker K.
        Epidemiology of chronic obstructive pulmonary disease: A literature review.
        Int J Chron Obstruct Pulmon Dis. 2012; 7: 457-494
        • Tan W.C.
        • Sin D.D.
        • Bourbeau J.
        • et al.
        Characteristics of COPD in never-smokers and ever-smokers in the general population: Results from the CanCOLD study.
        Thorax. 2015; 70: 822-829
        • Terzikhan N.
        • Verhamme K.M.
        • Hofman A.
        • et al.
        Prevalence and incidence of COPD in smokers and non-smokers: the Rotterdam study.
        Eur J Epidemiol. 2016; 31: 785-792
        • Buist A.S.
        • McBurnie M.A.
        • Vollmer W.M.
        • et al.
        International variation in the prevalence of COPD (the BOLD Study): A population-based prevalence study.
        Lancet. 2007; 370: 741-750
        • Albalak R.
        • Frisancho A.R.
        • Keeler G.J.
        Domestic biomass fuel combustion and chronic bronchitis in two rural Bolivian villages.
        Thorax. 1999; 54: 1004-1008
        • Norboo T.
        • Yahya M.
        • Bruce N.G.
        • et al.
        Domestic pollution and respiratory illness in a Himalayan village.
        Int J Epidemiol. 1991; 20: 749-757
        • Rehfuess E.
        Fuel for life: Household energy and health.
        World Health Organization, 2006 (Accessed March 1, 2018)
        • Kurmi O.P.
        • Lam K.B.
        • Ayres J.G.
        Indoor air pollution and the lung in low- and medium-income countries.
        Eur Respir J. 2012; 40: 239-254
        • Kurmi O.P.
        • Semple S.
        • Devereux G.S.
        • et al.
        The effect of exposure to biomass smoke on respiratory symptoms in adult rural and urban Nepalese populations.
        Environ Health. 2014; 13: 92
        • Kankaria A.
        • Nongkynrih B.
        • Gupta S.K.
        Indoor air pollution in India: Implications on health and its control.
        Indian J Community Med. 2014 Oct-Dec; 39: 203-207
        • Smith K.R.
        • Mehta S.
        • Maeusezahl-Feuz M.
        Indoor air pollution from household use of solid fuels. Chapter 18:1435–1495.
        in: Comparative Quantification of Health Risks. 2004
        • Vlachopoulos C.
        • Aznaouridis K.
        • O'Rourke M.F.
        • et al.
        Prediction of cardiovascular events and all-cause mortality with central haemodynamics: a systematic review and meta-analysis.
        Eur Heart J. 2010; 31: 1865-1871
        • Alam D.S.
        • Chowdhury M.A.H.
        • Siddiquee A.T.
        • et al.
        Adult cardiopulmonary mortality and indoor air pollution.
        Glob Heart. 2012; 7: 215-221
        • Fatmi Z.
        • Coggon D.
        • Kazi A.
        • et al.
        Solid fuel use is a major risk factor for acute coronary syndromes among rural women: a matched case control study.
        Public Health. 2014; 128: 77-82
        • Lee M.S.
        • Hang J.Q.
        • Zhang F.Y.
        • et al.
        In-home solid fuel use and cardiovascular disease: a cross-sectional analysis of the Shanghai Putuo study.
        Environ Health. 2012; 11: 18
        • McCracken J.P.
        • Smith K.R.
        • Diaz A.
        • et al.
        Chimney stove intervention to reduce long-term wood smoke exposure lowers blood pressure among Guatemalan women.
        Environ Health Perspect. 2007; 115: 996-1001
        • Dutta A.
        • Mukherjee B.
        • Das D.
        • et al.
        Hypertension with elevated levels of oxidized low-density lipoprotein and anticardiolipin antibody in the circulation of premenopausal Indian women chronically exposed to biomass smoke during cooking.
        Indoor Air. 2011; 21: 165-176
        • Chen R.
        • Zhao A.
        • Chen H.
        • et al.
        Cardiopulmonary benefits of reducing indoor particles of outdoor origin: a randomized, double-blind crossover trial of air purifiers.
        J Am Coll Cardiol. 2015; 65: 2279-2287