Indoor air pollution from biomass combustion and respiratory symptoms of women and children in a Zimbabwean village

Rural areas of developing countries are particularly reliant on biomass for cooking and heating. Women and children in these areas are often exposed to high levels of pollutants from biomass combustion that is associated with a range of respiratory symptoms. Domestic exposure to carbon monoxide (CO) and respirable particles (RSPs) in association with respiratory symptoms among women and children in Zimbabwe was investigated in 48 households. Health status and household characteristics were also recorded. In this study, indoor levels of CO and RSPs exceeded World Health Organization (WHO) air quality guidelines in over 95% of kitchens. The level of indoor air pollutants was associated with the area of kitchen windows and the length of cooking time combined with the level of fire combustion. Prevalence of respiratory symptoms was 94% for women and 77% for children. In addition, women reporting respiratory symptoms were exposed to higher levels of RSPs when compared with those reporting no respiratory symptoms. The study results indicated that levels of indoor air pollutants in rural Zimbabwe may contribute to respiratory symptoms in both women and children. PRACTICAL IMPLICATIONS: Levels of respirable particles and carbon monoxide in kitchens in rural Zimbabwe are unacceptably high and measures to reduce levels should be undertaken. Based on the study findings, recommendations for increasing the area of kitchen windows may be considered as a practical method of reducing indoor air pollutants in rural Zimbabwe.     

Air pollution and lung cancer risks in China--a meta-analysis

Lung cancer is a serious health problem in China, as in the rest of the world. Many studies have already proved that air pollution as well as other environmental factors can increase the risk of lung cancer. Based on epidemiological studies carried out in China, this paper proposes odds ratios (OR) to evaluate the risk of lung cancer from indoor air pollution for the Chinese population by applying the method of meta-analysis. For domestic coal use for heating and cooking, the pooled OR values are 1.83 (95% CI: 0.62-5.41) and 2.66 (1.39-5.07) for women and both sexes, respectively. For indoor exposure to coal dust, the OR values are 2.52 (95% CI: 1.94-3.28) and 2.42 (1.62-3.63) for women and both sexes, respectively. Cooking oil vapor is another factor increasing lung cancer risk. The OR values are 2.12 (95%CI: 1.81-2.47), 1.78 (1.50-2.12) and 6.20 (2.88-13.32) for nonsmoking women, women, and both sexes, respectively. Regarding environmental tobacco smoke, the pooled OR values are 1.70 (95% CI: 1.32-2.18) and 1.64 (1.29-2.07) for nonsmoking women and both sexes, respectively. Funnel plots with statistical test have been applied to examine the publication bias, and the results implied that the analysis of coal consumption and cooking oil pollution might be affected by publication bias. The meta-analysis results confirm the association between lung cancer and indoor air pollution for the Chinese population.     

Predicted risk of childhood allergy, asthma, and reported symptoms using measured phthalate exposure in dust and urine

The associated risk of phthalate exposure, both parent compounds in the home and their metabolites in urine, to childhood allergic and respiratory morbidity, after adjusting for exposures of indoor pollutants, especially bioaerosols, was comprehensively assessed. Levels of five phthalates in settled dust from the homes of 101 children (3-9 years old) were measured, along with their corresponding urinary metabolites. Other environmental risk factors, including indoor CO2, PM2.5, formaldehyde, 1,3-β-D-glucan, endotoxin, allergen and fungal levels, were concomitantly examined. Subject's health status was verified by pediatricians, and parents recorded observed daily symptoms of their children for the week that the home investigation visit took place. Significantly increased level of benzylbutyl phthalate, in settled dust, was associated with test case subjects (allergic or asthmatic children). Higher levels of dibutyl phthalate and its metabolites, mono-n-butyl phthalate, and mono-2-ethylhexyl phthalate were found to be the potential risk factors for the health outcomes of interest. Similarly, indoor fungal exposure remained a significant risk factor, especially for reported respiratory symptoms. The relative contribution from exposure to phthalates and indoor biocontaminants in childhood allergic and respiratory morbidity is, for the first time, quantitatively assessed and characterized. PRACTICAL IMPLICATIONS: For asthmatic and allergic children living in subtropical and highly developed environments like homes in Taiwan, controlling environmental exposure of phthalates may be viewed as equally important as avoiding indoor microbial burdens, for the management of allergy-related diseases. It is also recognized that multidisciplinary efforts will be critical in realizing the true underlying mechanisms associated with these observations.     

Indoor ultrafine particles and childhood asthma: exploring a potential public health concern

Exposure to airborne particulate matter has a negative effect on respiratory health in both children and adults. The ultrafine fraction of particulate air pollution is of particular interest because of its increased ability to cause oxidative stress and inflammation in the lungs. We reviewed the literature, and to date findings suggest that ultrafine particles (UFPs) may play an important role in triggering asthma symptoms. Furthermore, we believe that indoor UFP exposures may be particularly important because people spend the majority of their time indoors where sources of these contaminants are often present. While several epidemiological studies have examined the respiratory effects of ambient UFP exposures, the relationship between indoor UFP exposures and childhood asthma has yet to be examined in clinical or epidemiological studies. However, the portable instrumentation necessary to conduct such investigations is increasingly available, and we expect that this issue will be addressed in the near future. Therefore, the aim of this article is to provide a general review of UFP toxicity as related to childhood asthma in order to draw attention to a potentially important public health concern. PRACTICAL IMPLICATIONS: A number of indoor sources of ultrafine particles (UFPs) have been identified, but the health effects of indoor UFP exposures remain largely unexplored. The potential respiratory effects of such exposures seem most concerning because these particles are known to cause oxidative stress and inflammation in the lungs. Subsequently, indoor UFP exposures may contribute to the exacerbation of asthma symptoms in susceptible individuals. This paper provides a review of UFP toxicity as related to childhood asthma, and to date evidence suggests that further investigation into the respiratory effects of indoor UFP exposures is warranted.     

Indoor air pollution from particulate matter emissions in different households in rural areas of Bangladesh

Indoor air pollution from the combustion of traditional biomass fuels (wood, cow dung, and crop wastes) is a significant public health problem predominantly for poor populations in many developing countries. It is particularly problematic for the women who are normally responsible for food preparation and cooking, and for infants/young children who spend time around their mothers near the cooking area. Airborne particulate matter (PM) samples were collected from cooking and living areas in homes in a rural area of Bangladesh to investigate the impact of fuel use, kitchen configurations, and ventilation on indoor air quality and to apportion the source contributions of the measured trace metals and BC concentrations. Lower PM concentrations were observed when liquefied petroleum gas (LPG) was used for cooking. PM concentrations varied significantly depending on the position of kitchen, fuel use and ventilation rates. From reconstructed mass (RCM) calculations, it was found that the major constituent of the PM was carbonaceous matter. Soil and smoke were identified as components from elemental composition data. It was also found that some kitchen configurations have lower PM concentrations than others even with the use of low-grade biomass fuels. Adoption of these kitchen configurations would be a cost-effective approach in reducing exposures from cooking in these rural areas.     

Domestic exposure to endotoxin and respiratory morbidity in former smokers with COPD

Indoor air pollution has been linked to adverse chronic obstructive pulmonary disease (COPD) health, but specific causative agents have not yet been identified. We evaluated the role of indoor endotoxin exposure upon respiratory health in former smokers with COPD. Eighty‐four adults with moderate to severe COPD were followed longitudinally and indoor air and dust samples collected at baseline, 3 and 6 months. Respiratory outcomes were repeatedly assessed at each time point. The associations between endotoxin exposure in air and settled dust and health outcomes were explored using generalizing estimating equations in multivariate models accounting for confounders. Dust endotoxin concentrations in the main living area were highest in spring and lowest in fall, while airborne endotoxins remained steady across seasons. Airborne and dust endotoxin concentrations were weakly correlated with one another (r_s = +0.24, P = 0.005). Endotoxin concentrations were not significantly associated with respiratory symptoms, rescue medication use, quality of life, or severe exacerbations. In vitro whole‐blood assays of the pro‐inflammatory capacity of PM₁₀ filters with and without endotoxin depletion demonstrated that the endotoxin component of indoor air pollution was not the primary trigger for interleukin‐1β release. Our findings support that endotoxin is not the major driver in the adverse effects of indoor PM upon COPD morbidity.     

Indoor and outdoor PM2.5 and PM10 concentrations in the air during a dust storm

Asian dust storms (ADS) originating from the arid deserts of Mongolia and China are a well-known springtime meteorological phenomenon throughout East Asia. The ventilation systems in office utilize air from outside and therefore it is necessary to understand how these dust storms affect the concentrations of PM_2.5 and PM₁₀ in both the indoor and outdoor air. We measured dust storm pollution particles in an office building using a direct-reading instrument (PC-2 Quartz Crystal Microbalance, QCM) that measured particle size and concentration every 10 min for 1 h, three times a day. A three-fold increase in the concentrations of PM_2.5 and PM₁₀ in the indoor and outdoor air was recorded during the dust storms. After adjusting for other covariates, autoregression models indicated that PM_2.5 and PM₁₀ in the indoor air increased significantly (21.7 μg/m³ and 23.0 μg/m³ respectively) during dust storms. The ventilation systems in high-rise buildings utilize air from outside and therefore the indoor concentrations of fine and coarse particles in the air inside the buildings are significantly affected by outside air pollutants, especially during dust storms.     

Exposure to indoor air pollutants (polycyclic aromatic hydrocarbons, toluene, benzene) in Mexican indigenous women

Indoor air pollution is considered to be a serious public health issue in Mexico; therefore, more studies regarding this topic are necessary. In this context, we assessed exposure to polycyclic aromatic hydrocarbons (PAHs) and volatile organic compounds in: (i) women who use firewood combustion (indoor) for cooking and heating using traditional open fire; (ii) women who use firewood combustion (outdoor) for cooking and heating using traditional open fire; and (iii) women who use LP gas as the principal energy source. We studied 96 healthy women in San Luis Potosi, México. Urine samples were collected, and analyses of the following urinary exposure biomarkers were performed by high-performance liquid chromatography: 1-hydroxypyrene (1-OHP), trans, trans-muconic acid, and hippuric acid (HA). The highest levels of 1-OHP, trans, trans-muconic acid, and HA were found in communities where women were exposed to indoor biomass combustion smoke (or products; geometric mean ± s.d., 3.98 ± 5.10 μmol/mol creatinine; 4.81 ± 9.60 μg/l 1-OHP; 0.87 ± 1.78 mg/g creatinine for trans, trans-muconic acid; and 1.14 ± 0.91 g/g creatinine for HA). Our findings indicate higher exposure levels to all urinary exposure biomarkers studied in women who use indoor firewood combustion for cooking and heating (using traditional open fire). PRACTICAL IMPLICATIONS: High mean levels of 1-hydroxypyrene, t,t-muconic acid, and hippuric acid were found in women who use firewood combustion (indoor) for cooking and heating using traditional open fire and taking into account that millions of women and children in Mexico are living in scenarios similar to those studied in this report, the assessment of health effects in women and children exposed to polycyclic aromatic hydrocarbons and volatile organic compounds is urgently needed. Moreover, it is immediately necessary an intervention program to reduce exposure.     

Interaction between ozone and airborne particulate matter in office air

This study investigated the hypotheses that humans are affected by air pollution caused by ozone and house dust, that the effect of simultaneous exposure to ozone and dust in the air is larger than the effect of these two pollutants individually, and that the effects can be measured as release of cytokines and changes of the respiratory function. Experimental exposures of eight atopic but otherwise healthy subjects were performed in a climate chamber under controlled conditions. The three controlled exposures were about 75 microg/m3 total suspended particulate matter, 0.3 p.p.m. ozone, and the combination of these. The exposure duration was 3 h. The outcome measures were interleukins and cells in nasal lavages (NAL), respiratory function, bronchial metacholine responsiveness, rhinometry symptoms and general well-being in a questionnaire and time course of general irritation on a visual analogue scale. Indications of interactions between exposure types were demonstrated for peak expiratory flow (PEF) (P<0.05) and for discomfort symptoms (P<0.03). Non-significant interactions were found for the concentration of interleukin-8 in NAL. The combined exposure was found to cause significantly more effects than either ozone exposures or dust exposures. This is interpreted as indications of a potentiation caused by the combined exposures to dust and ozone. The findings in this study are based on a limited number of subjects and thus should not be over-interpreted. However, they support the hypothesis that ozone at relatively high concentrations interacts with dust exposures to cause decrements in PEF and increase in discomfort measures. PRACTICAL IMPLICATIONS: If confirmed at lower ozone and dust concentrations this finding could help to explain many problems with indoor air quality reported in offices throughout the world.     

Global burden of disease as a result of indoor air pollution in Shaanxi, Hubei and Zhejiang, China

Indoor air pollution in developing countries is a major global health problem, yet estimates of the global burden of disease vary widely and are associated with large uncertainty. The World Health Organization uses the fuel based approach to estimate 1.6 million premature deaths globally each year associated with exposure to indoor air pollution, of which 420 000 are in China. The fuel based approach uses a ventilation factor to account for differences in indoor air concentrations and exposures in different parts of the world based on regional differences in stove technology. In China this approach assumes that flues eliminate the majority of indoor air pollution, with a ventilation factor of 0.25. To account for historic exposure leading to current disease patterns the ventilation factor was adjusted to 0.5 for adult health endpoints. Measurements in three Chinese provinces, Shaanxi, Hubei and Zhejiang, however, show that high PM₄ concentrations are present in kitchens and living rooms even with stoves with flues as a result of multiple stove and flue use. Comparison of Indian and Chinese indoor air concentrations suggests more appropriate ventilation factors in the range 0.76-1.0 for women and children, and 1.0 for men. Premature mortality in the three provinces using these estimates would be closer to 60 600, rather than current estimates of 46 000. With the addition of cardiovascular diseases these estimates would increase by 92 000. Pollutant based estimates using measured indoor air concentrations and combined with dose-response estimates would imply a burden of disease of 157 800 premature deaths including cardiovascular diseases, a tripling of current estimates.     

Ultrafine particle concentrations and exposures in seven residences in northern California

Human exposures to ultrafine particles (UFP) are poorly characterized given the potential associated health risks. Residences are important sites of exposure. To characterize residential exposures to UFP in some circumstances and to investigate governing factors, seven single-family houses in California were studied during 2007-2009. During multiday periods, time-resolved particle number concentrations were monitored indoors and outdoors and information was acquired concerning occupancy, source-related activities, and building operation. On average, occupants were home for 70% of their time. The geometric mean time-average residential exposure concentration for 21 study subjects was 14,500 particles per cm(3) (GSD = 1.8; arithmetic mean ± standard deviation = 17,000 ± 10,300 particles per cm(3)). The average contribution to residential exposures from indoor episodic sources was 150% of the contribution from particles of outdoor origin. Unvented natural-gas pilot lights contributed up to 19% to exposure for the two households where present. Episodic indoor source activities, most notably cooking, caused the highest peak exposures and most of the variation in exposure among houses. Owing to the importance of indoor sources and variations in the infiltration factor, residential exposure to UFP cannot be characterized by ambient measurements alone. PRACTICAL IMPLICATIONS: Indoor and outdoor sources each contribute to residential ultrafine particle (UFP) concentrations and exposures. Under the conditions investigated, peak exposure concentrations indoors were associated with cooking, using candles, or the use of a furnace. Active particle removal systems can mitigate exposure by reducing the persistence of particles indoors. Eliminating the use of unvented gas pilot lights on cooking appliances could also be beneficial. The study results indicate that characterization of human exposure to UFP, an air pollutant of emerging public health concern, cannot be accomplished without a good understanding of conditions inside residences.     

Indoor Air Pollution: A Public Health Perspective

In developed and developing countries, indoor air pollutionis gaining increasing prominence as a public health problem. Time-activity studies and exposure surveys have shown the dominant contributions of indoor environments to population exposures for many pollutants. Mounting epidemiological evidence documents adverse health effects of indoor pollutants and risk assessments indicate that indoor carcinogens may contribute substantially to the population's burden of lung and other cancers. Unacceptable indoor air quality has also been identified as a common cause of symptoms. This paper addresses the public health problem posed by indoor air pollution, offering a schema for categorizing adverse health effects of indoor air pollution, and considers the complexiry of estimating the full scope of the problem     

Respiratory responses to diverse indoor combustion air pollution sources

Diverse indoor combustion sources contribute to the indoor air environment. To evaluate the effect of these sources on human respiratory health, we examined associations between respiratory conditions and household factors in the 2360 children's fathers (mean = 38.4 years old) and associations between lung function and household factors in 463 primary school children (mean = 8.3 years old) from Wuhan, China. Factor analysis developed new uncorrelated 'factor' variables. Unconditional logistic regression models or linear regression models, controlling for important covariates, estimated the respiratory health effects. Coal smoke derived from home heating ('heating coal smoke') was associated with high adult reporting of persistent cough, persistent phlegm, and wheeze. Cooking coal smoke was associated with physician-diagnosed adult asthma and decreased forced vital capacity (FVC), and forced expiratory volume at 1 s (FEV(1)) in children. The presence of any home cigarette smoker was associated with more reports of persistent cough, persistent phlegm, cough with phlegm, and bronchitis. Our study suggests that in Wuhan, there may be independent respiratory health effects of different indoor combustion sources and their exposure factors for these study populations. PRACTICAL IMPLICATIONS: We conclude that multiple indoor air pollution sources could have adverse respiratory health effects on both children and middle-aged men in the city of Wuhan, China. These results may have implications for the Wuhan local government, the Chinese government, or other related organizations in efforts on protecting public health through regulation of indoor air pollution from indoor combustion sources.     

Effects of Indoor Air Pollution on Human Health

This article contains a summary discussion of human health effects linked to indoor air pollution (UP) in homes and other non-industrial environments. Rather than discussing the health effects of the many different pollutants which can be found in indoor air, the approach has been to group broad categories of adverse health effects in separate chapters, and describe the relevant indoor exposures which may give rise to these health effects. The following groups of effects have been comdered: effects on the respiratory system; allergy and other effects on the immune system; cancer and effects on reproduction: effects on the skin and mucous membranes in the eyes, nose and throat; sensory effects and other effects on the nervous system; effects on the cardiovascular system; systemic effects on the liver, kidney and gastro-intestinal system. For each of these groups, effects associated with IAP the principal agents and sources, evidence linking IAP to the effects, susceptible groups, the public health relevance, methods for assessment, and major research needs are briefly discussed. For some groups of effects, clear relationships with exposure to IAP have been reported in the world literature. Among these are respiratory disease (particularly among children), allergy (particularly to house dust mites) and mucous membrane irritation (particularly due to formaldehyde). Large numbers of people have been, and are still being affected. Many chemicals encountered in indoor air are known or suspected to cause sensory irritation or stimulation. These, in turn, may give rise to a sense of discomfort and other symptums cummonly reported in so-called “sick” buildings. Camplex mixtures of organic chemicals in indoor air also have the potential to invoke subtle effects on the central and peripheral nervous system, leading to changes in behaviour and performance. An increased risk of developing lung cancer has been linked to exposure to environmental tobacco smoke (ETS) and to radon decay products. Lung cancer is a very serious disease with a high fatality rate; however, the number of people affected is much lower than the number of people contracting resparatory disease or alhgies, or experiencing irritative effects due to exposure to indoor pollution. The effects of IAP on reproduction, cardiovascular disease and on other systems and organs have not been well documented to date. To a certain extent, this may mean that no serious effects occur, but there has been little by way of research to clearly document the absence of these tvpes of effects.     

Priority among air pollution factors for preventing chronic obstructive pulmonary disease in Shanghai.

The problems that city environmental protection planners face are how important the air pollution exposures are in relation to chronic obstructive pulmonary disease (COPD) in local residents and which factor should be controlled most urgently. The purpose of our study is to determine the control priority among ambient sulphur dioxide (SO2) inhalable particulates (IP) and indoor use of coal to prevent COPD in residents of the city. Ambient air pollution is mainly from SO2 and IP(< 10 nm). Indoor air pollution is mainly from the use of coal for heating and/or cooking. Distribution of ambient SO2, and IP concentrations were described using a quartic trend surface simulation. When stratified by two extreme levels of ambient SO2 and IP and types of fuel used indoors, eight local area populations in four communities with different combinations of exposure levels were selected. In each community a local area population mostly using coal and one mostly burning gas was chosen. Chronic obstructive pulmonary diseases (COPD, ICD 490-493) including chronic bronchitis, asthma and emphysema, are a major cause of death in residents of Shanghai. The relationship between the three air pollution factors and their health effects were analyzed at the level of mortality (1978-1987, 232,459 person-years), prevalence of symptoms (12,037 persons) of COPD, lung function and non-specific immunologic function (514 women). The results show that indoor use of coal has stronger associations with health than estimated exposure to ambient SO2 or IP.     

Patterns and predictors of personal exposure to indoor air pollution from biomass combustion among women and children in rural China

Indoor air pollution (IAP) from domestic biomass combustion is an important health risk factor, yet direct measurements of personal IAP exposure are scarce. We measured 24-h integrated gravimetric exposure to particles < 2.5 μm in aerodynamic diameter (particulate matter, PM?.?) in 280 adult women and 240 children in rural Yunnan, China. We also measured indoor PM?.? concentrations in a random sample of 44 kitchens. The geometric mean winter PM?.? exposure among adult women was twice that of summer exposure [117 μg/m3 (95% CI: 107, 128) vs. 55 μg/m3 (95% CI: 49, 62)]. Children's geometric mean exposure in summer was 53 μg/m3 (95% CI: 46, 61). Indoor PM?.? concentrations were moderately correlated with women's personal exposure (r=0.58), but not for children. Ventilation during cooking, cookstove maintenance, and kitchen structure were significant predictors of personal PM?.? exposure among women primarily cooking with biomass. These findings can be used to develop exposure assessment models for future epidemiologic research and inform interventions and policies aimed at reducing IAP exposure. PRACTICAL IMPLICATIONS: Our results suggest that reducing overall PM pollution exposure in this population may be best achieved by reducing winter exposure. Behavioral interventions such as increasing ventilation during cooking or encouraging stove cleaning and maintenance may help achieve these reductions.     

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

This study aims to investigate whether indoor air pollution (IAP) from biomass fuel use was associated with hypertension, platelet hyperactivity, and elevated levels of oxidized low-density lipoprotein (oxLDL) and anticardiolipin antibody (aCL). We enrolled 244 biomass fuel-using (median age 34 year) and 236 age-matched control women who cooked with liquefied petroleum gas (LPG). Enzyme-linked immunosorbent assay was used to measure oxLDL in plasma and aCL in serum, flow cytometry for P-selectin expression on platelet and reactive oxygen species (ROS) generation by leukocytes, aggregometry for platelet aggregation, spectrophotometry for superoxide dismutase (SOD) in erythrocytes, and laser photometer for particulate matter <10 and 2.5 μm in diameter (PM(10) and PM(2.5), respectively) in cooking areas. Biomass users had three times more particulate pollution in kitchen, had higher prevalence of hypertension (29.5 vs. 11.0% in control, P < 0.05), elevated oxLDL (170.6 vs. 45.9 U/l; P < 0.001), platelet P-selectin expression (9.1% vs. 2.4%), platelet aggregation (23.2 vs. 15.9 Ohm), raised aCL IgG (28.7% vs. 2.1%), IgM (8.6% of vs. 0.4%), and ROS (44%) but depleted (13%) SOD. After controlling potential confounders, the changes were positively associated with PM(10) and PM(2.5) in indoor air, suggesting a positive association between IAP and increased cardiovascular risk. PRACTICAL IMPLICATIONS: The study showing high risk of developing cardiovascular diseases (CVD) among poor, underprivileged women in their reproductive ages in rural India is important from public health perspectives. It may motivate the government and the regulatory agencies of the country to take a serious note of the indoor air pollution (IAP) from biomass fuel use as it threatens the health of millions of women, children, and the elderly who mostly stay indoor. We hope the findings will strengthen the demand for setting up a standard for indoor air quality in the country in the line of national ambient air quality standard. The findings may also inspire the authorities to take measures for the reduction in IAP by improving housing, kitchen ventilation, and cook stoves. Moreover, the parameters used in this study can be utilized for large, population-based studies to identify women at a higher risk of developing CVD so that medical intervention can be taken at the formative stage of a disease.     

Characterization of indoor air quality in primary schools in Antwerp, Belgium

The indoor air quality of 27 primary schools located in the city centre and suburbs of Antwerp, Belgium, was assessed. The primary aim was to obtain correlations between the various pollutant levels. Indoor:outdoor ratios and the building and classroom characteristics of each school were investigated. This paper presents results on indoor and local outdoor PM2.5 mass concentrations, its elemental composition in terms of K, Ca, Ti, V, Cr, Mn, Fe, Ni, Cu, Zn, Br, Pb, Al, Si, S, and Cl, and its black smoke content. In addition, indoor and local outdoor levels of the gases NO2, SO2, O3, and BTEX (benzene, toluene, ethyl benzene, and xylene isomers) were determined. Black smoke, NO2, SO2 and O3, occurred at indoor:outdoor ratios below unity, indicating their significant outdoor sources. No linear correlation was established between indoor and outdoor levels for PM2.5 mass concentrations and BTEX; their indoor:outdoor ratios exceeded unity except for benzene. Classroom PM2.5 occurred with a different elemental composition than local outdoor PM2.5. The re-suspension of dust because of room occupation is probably the main contributor for the I/O ratios higher than 1 reported for elements typically constituting dust particles. Finally, increased benzene concentrations were reported for classrooms located at the lower levels. PRACTICAL IMPLICATIONS: The elevated indoor PM2.5, and BTEX concentrations in primary school classrooms, exceeding the ambient concentrations, raise concerns about possible adverse health effects on susceptible children. This is aggravated by the presence of carpets and in the case of classrooms at lower levels. Analysis of PM2.5's elemental composition indicated a considerable contribution of soil dust to indoor PM2.5 mass. In order to set adequate threshold values and guidelines, detailed information on the health impact of specific PM2.5 composites is needed. The results suggest that local outdoor air concentrations measurements do not provide an accurate estimation of children's personal exposures to the identified air pollutants inside classrooms.     

Respiratory effects of indoor particles in young children are size dependent

Background

Extensive epidemiological studies have provided evidence of an association between elevated outdoor particulate air pollution and adverse health effects. However, while people typically spend majority of time indoors, there is limited knowledge on airborne indoor particles and on the correlation between the concentrations of indoor particles and health effects. Even insights into the influence of differently sized indoor particles on human health are still rare.

Objective

The association between differentially sized indoor air particles and the development of respiratory diseases was studied for three year aged children.

Methods

Short-term measurements of particle mass and number concentrations were carried out in children's rooms. Information on possible particle sources (smoking habits, type of heating, and traffic) and respiratory outcomes were obtained from questionnaires. Measured indoor particle concentrations were correlated with possible sources of indoor particles and with respiratory health impacts.

Results

Daily smoking, smoking more than 5 cigarettes per day at home and traffic density in front of the window of children's room were found to be related to indoor exposure by particles of different diameters. High indoor particle exposures were associated with an increased risk for the development of obstructive bronchitis and in some extent of non-obstructive bronchitis. The strongest impact was observed for the mass concentration of particles < 1 μm and the number concentration of particles > 0.5 μm. The risk increases still remain significant if tested for stability changing the number of adjustment variables or omitting randomly selected cases, respectively.

Conclusion

Our results show significant associations between indoor particle concentrations and the risks for respiratory diseases in young children. The applied short-term measurements can help to assess the health risks of indoor particles with different sizes within epidemiological studies.     

Indoor air pollution and its impact on children under five years old in Bangladesh

Indoor air concentrations of volatile organic compounds (VOCs), carbon monoxide (CO), carbon dioxide (CO2), nitrogen dioxide (NO2), and dust particles were measured for 49 biomass and 46 fossil fuel users in urban slums of Dhaka, Bangladesh. The health impacts of these pollutants were assessed on 65 and 51 children under five years old from families who use biomass and fossil fuel as main source of energy, respectively. Mean concentrations of CO were found to be significantly higher in biomass fuel users (P = 0.010), while geometric mean concentrations of benzene, xylene, toluene, hexane, total VOCs, and NO2 were significantly higher (P < 0.01) in the fossil fuel users. Symptoms such as redness of eyes, itching of skin, nasal discharge, cough, shortness of breath, chest tightness, wheezing, or whistling chest were found to be associated with the choice of biomass fuel, with the odds ratio ranging from 4.0 to 6.3. No significant association of use of biomass fuel with respiratory diseases, eczema, diarrhea, or viral fever was observed after adjustment for potential confounders. These results suggest a significant association between the biomass fuel-using population and respiratory symptoms. These symptoms may not be due to the pollutants only, as some other underlying causes may be present. PRACTICAL IMPLICATIONS: The health of children under five years old in Bangladesh, especially those living in poor socioeconomic conditions, is considered to be worsening because of indoor air pollution. It is commonly suggested that biomass fuel should be replaced by fossil fuel, as pollution levels are believed to be higher with biomass fuel. Our findings, however, suggest that pollution can be higher with fossil fuels, and indicate that a switch in fuel from biomass to fossil does not necessarily improve the children's health. Awareness programs should therefore be undertaken to avoid the unnecessary use of gas. Clean fuels and clean stoves should also be ensured to reduce emissions of indoor air pollutants.