Seminars in respiratory and critical care medicine
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Semin Respir Crit Care Med · Jun 2015
ReviewChronic obstructive pulmonary disease secondary to household air pollution.
Approximately 3 billion people around the world cook and heat their homes using solid fuels in open fires and rudimentary stoves, resulting in household air pollution. Household air pollution secondary to indoor combustion of solid fuel is associated with multiple chronic obstructive pulmonary disease (COPD) outcomes. ⋯ COPD from household air pollution differs from COPD from tobacco smoke with respect to its disproportionately greater bronchial involvement, lesser emphysematous change, greater impact on quality of life, and possibly greater oxygen desaturation and pulmonary hypertensive changes. Interventions that decrease exposure to biomass smoke may decrease the risk for incident COPD and attenuate the longitudinal decline in lung function, but more data on exposure-response relationships from well-designed longitudinal studies are needed.
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Semin Respir Crit Care Med · Jun 2015
ReviewGene-environment interaction from international cohorts: impact on development and evolution of occupational and environmental lung and airway disease.
Environmental and occupational pulmonary diseases impose a substantial burden of morbidity and mortality on the global population. However, it has been long observed that only some of those who are exposed to pulmonary toxicants go on to develop disease; increasingly, it is being recognized that genetic differences may underlie some of this person-to-person variability. Studies performed throughout the globe are demonstrating important gene-environment interactions for diseases as diverse as chronic beryllium disease, coal workers' pneumoconiosis, silicosis, asbestosis, byssinosis, occupational asthma, and pollution-associated asthma. ⋯ No genetic test has yet emerged with sufficiently robust operating characteristics to be clearly useful or practicable in an occupational or environmental setting. In addition, occupational genetic testing raises serious ethical and policy concerns. Therefore, the primary objective must remain ensuring that the workplace and the environment are safe for all.
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Semin Respir Crit Care Med · Jun 2015
Surveillance for occupational respiratory diseases in developing countries.
The burden of chronic diseases, including occupational respiratory diseases (ORDs), is increasing worldwide. Nevertheless, epidemiological data on these conditions are scarce in most countries. Therefore, it is important to conduct surveillance to monitor ORDs, particularly in developing countries, where the working population is especially vulnerable and the health system infrastructure is usually weak. ⋯ Diseases with high morbidity and mortality and those in which early diagnosis with standardized tests are available are especially suitable for surveillance activities. Simple strategies, preferably using existing resources and technology, are the best option for surveillance in developing countries. This article offers examples of specific surveillance systems that are in place in Brazil, China, Cuba, India, and South Africa.
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Semin Respir Crit Care Med · Jun 2015
Ambient particulate matter air pollution and cardiopulmonary diseases.
Population exposures to ambient outdoor particulate matter (PM) air pollution have been assessed to represent a major burden on global health. Ambient PM is a diverse class of air pollution, with characteristics and health implications that can vary depending on a host of factors, including a particle's original source of emission or formation. The penetration of inhaled particles into the thorax is dependent on their deposition in the upper respiratory tract during inspiration, which varies with particle size, flow rate and tidal volume, and in vivo airway dimensions. ⋯ The adverse effects of inhaled PM can result from both short-term (acute) and long-term (chronic) exposures to PM, and can range from relatively minor, such as increased symptoms, to very severe effects, including increased risk of premature mortality and decreased life expectancy from long-term exposure. Control of the most toxic PM components can therefore provide major health benefits, and can help guide the selection of the most human health optimal air quality control and climate change mitigation policy measures. As such, a continued improvement in our understanding of the nature and types of PM that are most dangerous to health, and the mechanism(s) of their respective health effects, is an important public health goal.
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Semin Respir Crit Care Med · Jun 2015
Air contaminants associated with potential respiratory effects from unconventional resource development activities.
Unconventional natural gas development uses horizontal drilling in conjunction with hydraulic fracturing to gain access to natural gas deposits which may be tightly held in shale deposits and unavailable to conventional vertical drilling operations. The intensive work required to extract this source of energy results in higher than usual numbers of vehicles involved, potential release of emissions from those vehicles in congested zones surrounding the drill site, and release of other contaminants from materials drawn back out of the borehole after fracturing of the shale. ⋯ Because of the relatively short time this process has been used to the extent it is currently being used, it is not possible to draw detailed conclusions about the respiratory hazards that may be posed. However, based on the traffic volume associated with each drill site and the number of drill sites in any locale, it is possible at least to compare the effects to that of large traffic volume highways which are known to produce some respiratory effects in surrounding areas.