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      Impact of close-proximity air pollution on lung function in schoolchildren in the French West Indies

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          Abstract

          Background

          High levels of asthma prevalence and severity of respiratory symptoms have been found in the Caribbean but little is known about the impact of air pollution in these regions.

          This study aimed to describe air pollution and measure the associations with child lung function in Guadeloupe (French West Indies).

          Methods

          Data from 30 randomly chosen elementary schools (8–13 years old) were obtained using a standardized protocol adapted from the ISAAC2 study. We considered two health outcomes: peak expiratory flow (PEF) before running and the variation in peak expiratory flow (ΔPEF) after running. The associations between pollutants and outcomes were investigated using several air pollution exposure models: i) medium-term exposure to close-proximity pollution both indoor and outdoor for ozone (O 3) and nitrogen dioxide (NO 2) and ii) short- and medium-term exposure to background pollution for O 3, NO 2, sulphur dioxide (SO 2) and small particulate matter (PM 10).

          Results

          Of 1,463 children, 277 (16%) were found to have asthma. A 1-μg/m3 increase in medium-term exposure to outdoor close-proximity pollution by O 3 was associated with a PEF decrease (β = −0.32; 95% CI: −0.61;-0.03). No association was found with NO 2 regarding close-proximity pollution. The association between medium-term exposure to background pollution and PEF decrease was stronger in asthmatic children than in non-asthmatic children for O 3. No reduction in PEF or ΔPEF was shown with NO 2, SO 2 and PM 10 pollutants but a significant association was found between PM 10 and PEF increase.

          Conclusions

          Our results suggest that O 3 could have an acute effect on child lung function in the Caribbean even at a low concentration (below the WHO guidelines). Further research in the Caribbean is needed to confirm these findings.

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          Most cited references35

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          Is the prevalence of asthma declining? Systematic review of epidemiological studies.

          Asthma prevalence has increased very considerably in recent decades such that it is now one of the commonest chronic disorders in the world. Recent evidence from epidemiological studies, however, suggests that the prevalence of asthma may now be declining in many parts of the world, which, if true is important for health service planning and also because this offers the possibility of generating and testing new aetiological hypotheses. Our objective was to determine whether the prevalence of asthma is declining worldwide. We undertook a systematic search of EMBASE, Medline, Web of Science and Google Scholar, for high quality reports of cohort studies, repeat cross-sectional studies and analyses of routine healthcare datasets to examine international trends in asthma prevalence in children and adults for the period 1990-2008. There were 48 full reports of studies that satisfied our inclusion criteria. The large volume of data identified clearly indicate that there are, at present, no overall signs of a declining trend in asthma prevalence; on the contrary, asthma prevalence is in many parts of the world still increasing. The reductions in emergency healthcare utilization being reported in some economically developed countries most probably reflect improvements in quality of care. There remain major gaps in the literature on asthma trends in relation to Africa and parts of Asia. There is no overall global downward trend in the prevalence of asthma. Healthcare planners will for the foreseeable future, therefore, need to continue with high levels of anticipated expenditure in relation to provision of asthma care.
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            Phase II of the International Study of Asthma and Allergies in Childhood (ISAAC II): rationale and methods.

            International comparative studies, investigating whether disease incidence or prevalence rates differ between populations and, if so, which factors explain the observed differences, have made important contributions to the understanding of disease aetiology in many areas. In Phase I of the International Study of Asthma and Allergies in Childhood (ISAAC), the prevalence rates of symptoms of asthma, allergic rhinitis and atopic eczema in 13-14-yr-olds, assessed by standardised questionnaires, were found to differ >20-fold between the 155 study centres around the world. Phase II of ISAAC aims to identify determinants of these differences by studying informative populations. A detailed study protocol was developed for use in community-based random samples of children aged 9-11 yrs. The study modules include standardised questionnaires with detailed questions on the occurrence and severity of symptoms of asthma, allergic rhinitis and atopic eczema, their clinical management, and a broad range of previous and current exposure conditions. In addition, standardised protocols were applied for examination of flexural dermatitis, skin-prick testing, bronchial challenge with hypertonic saline, blood sampling for immunoglobulin E analyses and genotyping, and dust sampling for assessment of indoor exposures to allergens and endotoxin. To date, ISAAC II field work had been completed or started in 30 study centres in 22 countries. The majority of centres are in countries that participated in International Study of Asthma and Allergies in Childhood Phase I and reflect almost the full range of the observed variability in Phase I prevalence rates.
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              Short-Term Effects of PM10 and NO2 on Respiratory Health among Children with Asthma or Asthma-like Symptoms: A Systematic Review and Meta-Analysis

              Objective Our goal was to quantify the short-term effects of particulate matter with aerodynamic diameter ≤ 10 μm (PM10) and nitrogen dioxide (NO2) on respiratory health of asthmatic children from published panel studies, and to investigate the influence of study and population characteristics as effect modifiers. Data extraction After a systematic literature review, we extracted quantitative estimates of the association of PM10 and/or NO2 with respiratory symptoms and peak expiratory flow (PEF). Combined effect estimates for an increase of 10 μg/m3 were calculated by random effects meta-analysis for all studies and for different strata defined by study characteristics. The effect of publication bias was investigated with Egger’s and Begg’s tests and “trim-and-fill” analyses. Data synthesis We identified 36 studies; 14 were part of the European Pollution Effects on Asthmatic Children in Europe (PEACE) study. Adverse associations of PM10 with asthma symptoms were statistically significant [odds ratio (OR) = 1.028; 95% confidence interval (CI), 1.006–1.051]. There were also associations, although not statistically significant, of PM10 with cough (OR = 1.012; 95% CI, 0.997–1.026) and on PEF (decrease of −0.082 L/min; 95% CI, −0.214 to 0.050). NO2 had statistically significant associations with asthma symptoms in the overall analysis considering all possible lags (OR = 1.031; 95% CI, 1.001–1.062), but not when we evaluated only the 0–1 lag. We found no publication bias, although it appeared when excluding the PEACE studies. When we applied the trim-and-fill method to the data set without the PEACE studies, the results were similar to the overall estimates from all studies. There was an indication for stronger PM10 associations for studies conducted in summer, outside of Europe, with longer lags, and in locations with higher NO2 concentrations. Conclusions We found clear evidence of effects of PM10 on the occurrence of asthma symptom episodes, and to a lesser extent on cough and PEF. The results for NO2 are more difficult to interpret because they depend on the lag times examined. There was an indication of effect modification by several study conditions.
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                Author and article information

                Contributors
                brice.amadeo@gmail.com
                celine.robert@gmail.com
                virginie.rondeau@isped.u-bordeaux2.fr
                dr.mounouchy@wanadoo.fr
                lucie.cordeau@orange.fr
                dr.birambaux@wanadoo.fr
                eddy.citadelle@wanadoo.fr
                jack.goth@wanadoo.fr
                monique.gouranton@wanadoo.fr
                gerard.marcin@wanadoo.fr
                david.laurac@wanadoo.fr
                chantal.raherison@isped.u-bordeaux2.fr
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                31 January 2015
                31 January 2015
                2015
                : 15
                : 45
                Affiliations
                [ ]ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Univ. Bordeaux, F-33000 Bordeaux, France
                [ ]INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, F-33000 Bordeaux, France
                [ ]Association Karu-Asthme, F-97110 Pointe-à-Pitre, Guadeloupe
                [ ]CHU Bordeaux, service de Pneumologie, F-33000 Bordeaux, France
                [ ]ISPED, Equipe Santé Travail Environnement, Université de Bordeaux, 146 rue Léo Saignat, 33076 Bordeaux, France
                Article
                1382
                10.1186/s12889-015-1382-5
                4324031
                25637259
                7908efa2-6a8c-48a4-bf07-a8085b7ba78b
                © Amadeo et al.; licensee BioMed Central. 2015

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 19 April 2013
                : 9 January 2015
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2015

                Public health
                asthma,isaac,peak expiratory flow,pollutants,schoolchildren
                Public health
                asthma, isaac, peak expiratory flow, pollutants, schoolchildren

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