Associations between environmental exposures and asthma control and exacerbations in young children : a systematic review

Peer reviewedPublisher PD

Smoke-free legislation and hospitalizations for childhood asthma

<b>BACKGROUND:</b> Previous studies have shown that after the adoption of comprehensive smoke-free legislation, there is a reduction in respiratory symptoms among workers in bars. However, it is not known whether respiratory disease is also reduced among people who do not have occupational exposure to environmental tobacco smoke. The aim of our study was to determine whether the ban on smoking in public places in Scotland, which was initiated in March 2006, influenced the rate of hospital admissions for childhood asthma.<br></br> <b>METHODS:</b> Routine hospital administrative data were used to identify all hospital admissions for asthma in Scotland from January 2000 through October 2009 among children younger than 15 years of age. A negative binomial regression model was fitted, with adjustment for age group, sex, quintile of socioeconomic status, urban or rural residence, month, and year. Tests for interactions were also performed. <br></br> <b>RESULTS:</b> Before the legislation was implemented, admissions for asthma were increasing at a mean rate of 5.2% per year (95% confidence interval [CI], 3.9 to 6.6). After implementation of the legislation, there was a mean reduction in the rate of admissions of 18.2% per year relative to the rate on March 26, 2006 (95% CI, 14.7 to 21.8; P<0.001). The reduction was apparent among both preschool and school-age children. There were no significant interactions between hospital admissions for asthma and age group, sex, urban or rural residence, region, or quintile of socioeconomic status. <b>CONCLUSIONS:</b> In Scotland, passage of smoke-free legislation in 2006 was associated with a subsequent reduction in the rate of respiratory disease in populations other than those with occupational exposure to environmental tobacco smoke. (Funded by NHS Health Scotland.

Respiratory symptoms and cross-shift lung function in relation to cotton dust and endotoxin exposure in textile workers in Nepal: a cross-sectional study

Objectives: Inhalation of a cotton-based particulates has previously been associated with respiratory symptoms and impaired lung function. This study investigates the respiratory health of Nepalese textile workers in relation to dust and endotoxin exposure. Methods: A total of 938 individuals from four sectors (garment, carpet, weaving and recycling) of the textile industry in Kathmandu, Nepal completed a health questionnaire and performed spirometry. A subset (n=384) performed cross-shift spirometry. Personal exposure to inhalable dust and airborne endotoxin was measured during a full shift for 114 workers. Results: The overall prevalence of persistent cough, persistent phlegm, wheeze ever, breathlessness ever and chest tightness ever was 8.5%, 12.5%, 3.2%, 6.5% and 12.3%, respectively. Symptoms were most common among recyclers and least common among garment workers. Exposure to inhalable dust significantly predicted persistent cough and chest tightness. Exposure to endotoxin did not have any independent predictive effect. Significant cross-shift reduction in forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were found (p<0.001 for both) being largest for FEV1 in the recyclers (−143 mL), and least in the garment workers (−38 mL; p=0.012). Exposure to inhalable dust predicted a cross-shift reduction in FEV1. Conclusions: This study is the first to investigate the respiratory health of Nepalese cotton workers. The measured association between inhalable dust exposure and reporting of respiratory symptoms and across-shift decrement in FEV1 and FVC indicates that improved dust control measures should be instituted, particularly in the recycling and carpet sectors. The possible role of other biologically active agents of cotton dust beyond endotoxin should be further explored

Is pesticide exposure a cause of obstructive airways disease?

Peer reviewedPublisher PD

The Global Burden of Air Pollution on Mortality: The Need to Include Exposure to Household Biomass Fuel–Derived Particulates

First paragraph: Anenberg et al. (2010) demonstrated that global mortality associated with outdoor ozone and particulate matter (PM) exposure has been underestimated and that anthropogenic atmospheric PM rather than ozone is the main contributor to death. Although we acknowledge that their investigation was concerned with outdoor air pollution alone, we feel that attention should be drawn to the burden of disease from household air pollution

The effect of exposure to biomass smoke on respiratory symptoms in adult rural and urban Nepalese populations

Peer reviewedPublisher PD

Expectations and changing attitudes of bar workers before and after the implementation of smoke-free legislation in Scotland

BACKGROUND: In Scotland on March 26, 2006 a comprehensive prohibition on smoking in all enclosed public places was introduced. This study examines bar workers' attitudes towards a smoke-free working environment. METHODS: An intervention study comparing bar workers' opinions before and after the implementation of the smoke-free legislation. Bars were randomly selected in three Scottish cities (Glasgow, Edinburgh & Aberdeen) and towns (Aberdeenshire & Borders). Bar workers were recruited from 72 bars that agreed to participate from 159 approached. Pre- and post-implementation attitudes towards legislation, second-hand smoke and smoke-free working environments were compared. RESULTS: Initially the majority of bar workers agreed with the proposed legislation on smoking (69%) and the need for it to protect the health of workers (80%), although almost half (49%) thought the legislation would damage business. In 266 bar workers seen at both surveys, a significant positive attitudinal change towards the legislation was seen. Post-implementation, support for the legislation rose to 79%, bar workers continued to believe it was needed to protect health (81%) and concerns about the impact on business were expressed by fewer than 20%. Only the statement that the legislation would encourage smokers to quit showed reduced support, from 70% pre-implementation to fewer than 60% post-implementation. Initial acceptance was greater among younger bar workers; older workers, initially more sceptical, became less so with experience of the legislation's effects. CONCLUSION: This study shows that bar workers had generally positive attitudes towards the legislation prior to implementation, which became stronger after implementation. The affirmative attitudes of these key stakeholders are likely to contribute towards the creation of 'smoke-free' as the new social norm