Effects of exposure to biomass combustion in respiratory symptoms and function

1
Effects of exposure to biomass combustion in
respiratory symptoms and function

• Luiz Fernando Ferraz da Silva, MD
• University of Sao Paulo School of Medicine
• Sao Paulo Brazil
• burns_at_usp.br

2
The problem An overview

• Several sources of energy have been used for
  household porpoises majority of them are
  pollutants with health effects
• Indoor air pollution
• The situation has been considered a public health
  problem
• Every year, indoor air pollution from cooking
  with solid fuels is responsible for 1.5 million
  deaths

3
WHO, 2006
4
Indoor Pollution by Solid Fuels

• Who???

lt5
lt5
13
WHO, 2006
5
Indoor Pollution by solid fuels

• What Kind???
• Household energy used

6
Indoor Pollution by solid fuels

• How big are the consequences?
• Costs, lost years and impact(Smith, 2002)
• Association with ARI(Rumchev 2008)
• Effects on COPD exacerbations and respiratory
  parameters (Rinne, 2006)
• Biomass and genetic mutations (keohavong, 2005)

7
Rationale

• Only partial knowledge about the real impact on
  quality of life, symptoms and lung function

8
Aim

• Evaluate the effects of exposition to biomass
  combustion on respiratory symptoms and function
  in a population of Brazilian NE

9
Region
João Câmara Google Earth
10
Population

• João Câmara RN
• 32.000 inhabitants
• Rural Population 42
• Human Development Index 0.638
• Biomass use
• Brazil 13 / JC 35
• Wood and Cashew nut bark

11
Study Design
50 houses
170 houses
Filter exposition
PHASE 1
LPG
220 Houses 1402 Individuals
BM outdoor
Social and economic data Respiratory
symptoms ISAAC and BMC questionnaires
BM indoor
120 Houses 120 Individuals
Detailed evaluation of respiratory diseases Pre
and Post-BD respiratory tests
PHASE 2
gt 20y Non-smk LPG
gt20y Non-smk BM
gt20y Smoker LPG
gt20y Smoker BM
lt20y Non-smk LPG
lt 20y Non-smk BM
12
Results - Exposition
p lt 0.001
13
Results - Exposition
p lt 0.001
p lt 0.001
p lt 0.001
14
Results Symptoms
Cough
Sibilation
Dyspnea
Coryza and sneezing
Adjusted for sex, age and smoking
Eye itching and tears
Lower resp symp
Upper resp. and ocular symp
2.20
1.80
Indoor Biomass
Outdoor Biomass
2.44
2.34
1.98
1.77
1.72
1.69
1.69
1.55
LPG
Odds Ratios with statistic significance
15
Results Symptoms lt 20 years

• Increase of upper respiratory and ocular symptoms
  in BM x LGP
• Absence of difference in cough and dyspnea
• Sibilation differences are less strenght

16
Results Lung Function lt 20 years
Predicted FVE1/FVC post-brochodilator
p 0.120
17
Results Lung Function gt 20 years
Groups pared by age among fuels and also
pack-years among smokers
18
Results Lung Function
Predicted FVE1/FVC post-brochodilator
p 0.038 R - 0.26
Predicted FVE1/FVC post-brochodilator
p lt 0.001 R - 0.58
19
Results Lung Function
Predicted FVE1/FVC post-brochodilator
p lt 0.001 R - 0.68
20
Conclusion

• Exposition to biomass combustion is associated
  with the increased prevalence of the studied
  respiratory symptoms.
• The outdoor combustion is associated with upper
  respiratory and ocular symptoms, while the indoor
  combustion is associated with both upper and
  lower respiratory symptoms.
• The biomass combustion exposition is related to
  reduced lung function parameters
• This effect looks to be associated with the time
  of exposition

21
Acknowledgements

• Experimental Air Pollution Lab
• University of São Paulo
• School of Medicine
• Paulo Hilário N. Saldiva
• Marisa Dolhnikoff
• Silvia M. Saldiva
• Thais Mauad
• Regiani Oliveira
• Tatiana Lanças
• Diogenes S. Ferreira
• Maína Morales
• Ellen Cristina Nascimento
• Raquel Annoni
• Ana Laura N. Carvalho
• Ruy Camargo P. Neto

• Bandeira Científica Organizing Comittee
• University of São Paulo
• School of Medicine
• Gabriella Paiva Bento
• Natália Takahashi
• Higor A. P. Gomes
• Livia Caroline B. Mariano
• Débora Terribili
• Carla Romagnolli
• Igor Tadeu da Costa
• Andreza Cadima Silva
• Maíra R. Grizzo
• Lilian Z. Castelli
• Marilena Nakaguma
• Fernando Arturo E. Sollis

• Leiden University Medical Center
• Leiden The Netherlands
• Klaus Rabe

22
(No Transcript)