R. Masekela. Paediatric Pulmonologist and Allergist

Transcription

1 R. Masekela Paediatric Pulmonologist and Allergist

2 Outline Definitions i i Biomass fuels Atopy Respiratory tract Environmental tobacco smoke (ETS) Respiratory tract. HIV Atopy Traffic related air pollutants Respiratory tract Atopy Implications Conclusion

3 Why children are unique ALVEOLI Till 8 years Accessed 12/10/2009

4 Targets for intervention i to prevention Intrauterine Delivery Postnatal <2 years Childhood Maternal smoking Mode of delivery ETS, TRP, BMF Diet Microbial exposure

5 Atopy Predilection for production of IgE in response to exposure to allergens. Ath Asthma Eczema Allergic rhinitis

6 Prevalence rates Allergic Rhinitis Asthma UK Australia Canada Brazil USA South Africa Germany France Argentina Algeria China Russia UK Australia Canada Brazil USA South Africa Germany France Argentina Algeria China Russia % prevalence % prevalence Adapted from Adapted the International from the International Study of Asthma Study of and Asthma Allergies and Allergies in Childhood in Childhood (ISAAC) (ISAAC) Steering Steering Committee. Committee. Lancet Lancet 1998;351: ;351:

7 Hygiene Hypothesis

8 Interactions in disease expression Biomass fuels TRP Intra-uterine programming Genetics ETS Other

9 Biomass fuels Wood Charcoal Leaves Dung Used for cooking purposes.

10 Cleaner BMF Gas Kerosene Electricity Lesser health effects

11 BMF and lungs South Africa informal dwelling Ventilation of dwelling important factor in exposure Sleeping in the same room as cooking area. Increased respiratory tract infections

12 BMF and lungs Increased respiratory induced bronchospasm Guatemala study woodstove increased asthma Kerosene: nitrogen dioxide, carbon monoxide and volatile organic compounds Jimma 959 adults increased wheeze adults (1.5 times)

13 BMF and the nose Paucity of data in this area Increased allergic rhinitis with use of kerosene in Ethopia

14 BMF allergic sensitization Venn et al increased skin prick test positivity and use of newer fuels i.e. kerosene and gas.

15 BMF and skin Bangladesh study by Khalequzzaman M et al increased itchy rash in children < 5 years but not all atopic QuickTime and a decompressor are needed to see this picture.

16 ETS exposure USA ETS in 38% children Intrauterine 23.8%

17 ETS WHO estimates per smoker in SA yearly and 1000 million worldwide > 4000 compounds 50 known carcinogens, irritants and toxins Sidestream smoke more reduced d substances

18 ETS South African data 32 27% decline in data 2002 Van Walbeck SAMJ 2002;92: Worrying: data HIV clinic ETS exposure lower educational level Higher levels in HIV vs. non HIV Accessed 12/10/2009

19 ETS and HIV Feldman, J. G. et al. Am J Public Health 2006;96:

20 ETS and HIV in children Exposed children lower CD counts but not statistically significant

21 ETS health effects Pregnancy Low birth weight Small lungs at birth Neurodevelopmental effects

22 Postnatal Recurrent respiratory tract infections Increased wheeze Reduced lung function Cord blood eosinophil levels correlate with urine cotinine levels in newborn of smoking mothers? Allergic sensitisation.

23 ETS on the lung Asthma at 5 years if >20 cigs. Gergen et al. Third National Health and Nutrition xam Survey RSV infections. Chan Yeubn et al. Respirology 2003;8:131 8 Decreased response to therapy. Baena Cagnagni CE et al. Curr Op Allerg Clin Immunol 2009

24 ETS and lung ETS reduced the lungs ability to respond to oxidative stress e.g. respiratory tract infections. Kariya C et al. Infection and Immunity 2008;76(10): Chronic cough in children similar to adult g smokers.

25 Traffic related pollutants TRP: this is related to particulate mass median diameter of PM 2.5 (black smoke), PM 10 (exhaust), ultrafine particulate matter <0.01µm. 01µm Other particles Diesel Ozone Carbon monoxide Benzene Nitric oxide Organic carbon compounds

26 Factors for TRP Time of exposure Level of exposure Distance from major road Truck traffic

27 TRP and lungs Direct effect on airway > inflammation Murine models: TRPs disruption in macrophage-surfactant interaction misregulated inflammation. Venn J et al J Pediatr Child Health 1995 Netherlands: TRAPCA study birth cohort 4000 children no effect on wheeze/asthma and proximity to road. Ciccone F et al. Occ Envir Med Italy year-olds increased wheeze children in metropolitan areas metropolitan areas. Liu LM et al. Environ Health Persp 2009

28 TRP and lungs German study showed reduction in ambient pollution levels reduction in chronic bronchitis. Heinrich et al Blue J 2000;161: Japan study higher risk of prevalence of asthma in girls <50m from road Effect of ozone of asthma exacerbations

29 TRP and nasal symptoms Mixed results in studies One large Taiwanese study over children slight increase in allergic rhinitis ( x)

30 TRP and allergic sensitization Urban vs. Rural distinction with higher sensitization?? factor pollution Exposure to nitrogen dioxide increased sensitization Munich 7000 children no association between traffic count s and allergic sensitization count s and allergic sensitization. Moralez Suarez-Valera et al. ERJ 2003;21:956-64

31 Impact on community

32 Allergic rhinitis can have an impact on various aspects of the daily life y Work School Sleep ALLERGIC RHINITIS Social Life Emotiona l wellbeing Related Allergic diseases Th i i t f diff t d i f th d il lif i j d d The impairment of different domains of the daily life is judged according to patients age, personal habits as well as social, professional and cultural needs

33 Comparison of SF-36 in Asthma and Severe Rhinitis SF-36 scores 100 QOL worse ening HR severe rhinitis mild asthma moderate asthma severe asthma 0 Physical Functioning Functioning Social Problems Physical Emotional Problems Mental Health Energy Fatigue Pain General Perception of Health Change in Health Bousquet Bousquet J al., J et Allergy al. AM Clin J Resp Immunol Crit Care 1994; Med 94: ; 149: 371-5

34 Implications Increased respiratory tract infections increased healthcare costs Reduced productivity/missed school Increased need for expensive medications

35 Conclusion BMF Recurrent respiratory tract infections Wheeze Allergic rhinitis?? TRP Increased asthma? Allergic rhinitis

36 Conclusion ETS strongly discouraged in pregnancy and postnatal period Risk of atopy in children on smoking mothers ETS poorer response to anti inflammatory medication HIV and ETS newer risks

37 Acknowledgements Prof R Green Team Paediatric Chest and Allergy Clinic Steve Biko Academic Hospital

38 Thank you Questions??