RESUMO
BACKGROUND: Air pollution is associated with a substantial burden on human health; however, the most important pollutants may vary with location. Proper monitoring is necessary to determine the effect of these pollutants on respiratory health. OBJECTIVES: This study was designed to evaluate the role of outdoor, indoor and personal exposure to combustion-related pollutants NO(2) and O(3) on respiratory health of children in a non-affluent urban area of São Paulo, Brazil. METHODS: Levels of NO(2) and O(3) were continuously measured in outdoor and indoor air, as well as personal exposure, for 30 days using passive measurement monitors. Respiratory health was assessed with a Brazilian version of the ISAAC questionnaire. RESULTS: Complete data were available from 64 children, aged 6-10 years. Respiratory morbidity was high, with 43 (67.2%) reporting having had wheezing at any time, 27 (42.2%) wheezing in the last month, 17 (26.6%) asthma at any time and 21 (32.8%) pneumonia at any time. Correlations between levels of NO(2) and O(3) measured in the three locations evaluated were poor. Levels of NO(2) in indoor air and personal exposure to O(3) were independently associated with asthma (both cases P=.02), pneumonia (O(3), P=.02) and wheezing at any time (both cases P<.01). No associations were seen between outdoor NO(2) and O(3) and respiratory health. CONCLUSIONS: Exposure to higher levels of NO(2) and O(3) was associated with increased risk for asthma and pneumonia in children. Nonetheless, the place where the pollutants are measured influences the results. The measurements taken in indoor and personal exposure were the most accurate.
Assuntos
Poluentes Atmosféricos/efeitos adversos , Asma/etiologia , Dióxido de Nitrogênio/efeitos adversos , Ozônio/efeitos adversos , Pneumonia/etiologia , Saúde da População Urbana , Poluentes Atmosféricos/análise , Poluição do Ar em Ambientes Fechados/efeitos adversos , Asma/epidemiologia , Brasil/epidemiologia , Criança , Exposição Ambiental/efeitos adversos , Monitoramento Ambiental/instrumentação , Monitoramento Ambiental/métodos , Feminino , Filtração , Habitação , Humanos , Masculino , Dióxido de Nitrogênio/análise , Ozônio/análise , Pneumonia/epidemiologia , Áreas de Pobreza , Sons Respiratórios/etiologia , Fatores de Risco , Inquéritos e Questionários , Poluição por Fumaça de Tabaco/efeitos adversos , Emissões de Veículos/toxicidadeRESUMO
Resulta difícil determinar cuáles niños en edad prescolar con sibilancias recurrentes o persistentes podrían presentar asma persistente. Esta situación se ve agravada debido a la relativamente mala respuesta al tratamiento en la mayoría de los estudios clínicos realizados en este grupo etario. Publicaciones recientes demostraron que la evaluación broncoscópica que incluye el lavado broncoalveolar y la biopsia broncoscópica puede ser llevada adelante sin inconvenientes en niños pequeños. Consideramos que esa evaluación podría brindar información valiosa sobre la patogénesis del asma a edad temprana y permitir potencialmente la identificación de cuáles niños con sibilancias son los que tienen mayores posibilidades de progresar hacia asma persistente. Mediante el análisis de la literatura publicada, argumentamos que los niños que tienen un alto riesgo de presentar asma persistente, de acuerdo con los factores de riesgo identificados a partir de estudios epidemiológicos horizontales (es decir familias con historia de atopia y asma, sensibilización alérgica temprana, alergia clínica a los alimentos, eczema asociado a atopia, enfermedades del tracto respiratorio inferior asociadas a sibilancias en los primeros años de vida) y que continúan con sibilancias después de los 3 años, se podrían beneficiar con la evaluación broncoscópica. La presencia de inflamación eosinofílica en el lavado broncoalveolar o la biopsia y el engrosamiento de la membrana basal reticular puede indicar una alta probabilidad de asma persistente. Sin embargo, estas predicciones necesitan ser evaluadas mediante la recolección de información apropiada.
Assuntos
Humanos , Masculino , Feminino , Criança , Asma/diagnóstico , Asma/prevenção & controle , Biópsia , Broncoscopia , Sons Respiratórios/diagnósticoRESUMO
BACKGROUND: Epidemiologic studies show statistical associations between levels of air pollutants and respiratory outcomes. OBJECTIVE: We sought to determine the effects of exposure to petrochemical pollution on the respiratory health of children. METHODS: Children aged 6 to 12 years living close to the petrochemical plants in La Plata, Argentina (n = 282), were compared with those living in a region with exposure to heavy traffic (n = 270) or in 2 relatively nonpolluted areas (n = 639). Parents answered a validated questionnaire providing health and demographic data. A random sample (n = 181) had lung function measured. Particulate matter and outdoor and indoor volatile organic compound levels were measured during 4-week study periods and reported as overall means for each study area. RESULTS: Children living near the petrochemical plant had more asthma (24.8% vs 10.1% to 11.5%), more asthma exacerbations (6.7 vs 2.9-3.6 per year), more respiratory symptoms (current wheeze, dyspnea, nocturnal cough, and rhinitis), and lower lung function (>13% decrease in FEV(1) percent predicted) than those living in other regions. Length of residence in the area was a significant risk factor, but age, sex, body mass index, proximity to busy roads and other nonpetrochemical industries, length of breast-feeding, and socioeconomic and demographic characteristics of children or their families were not. CONCLUSION: Exposure to particulate matter and volatile organic compounds arising from petrochemical plants but not from high traffic density was associated ith worse respiratory health in children.