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Exposure to household air pollution over 10 years is related to asthma and lung function decline

Xin Dai, Dinh S. Bui, Jennifer L. Perret, Adrian J. Lowe, Peter A. Frith, Gayan Bowatte, Paul S. Thomas, Graham G. Giles, Garun S. Hamilton, Helen Tsimiklis, Jennie Hui, John Burgess, Aung K. Win, Michael J. Abramson, E. Haydn Walters, Shyamali C. Dharmage, Caroline J. Lodge
European Respiratory Journal 2021 57: 2000602; DOI: 10.1183/13993003.00602-2020
Xin Dai
1Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
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Dinh S. Bui
1Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
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Jennifer L. Perret
1Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
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Adrian J. Lowe
1Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
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Peter A. Frith
2College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Gayan Bowatte
1Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
3National Institute of Fundamental Studies, Kandy, Sri Lanka
4Dept of Basic Sciences, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
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Paul S. Thomas
5Inflammation and Infection Research, Faculty of Medicine, University of New South Wales, Randwick, Australia
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Graham G. Giles
1Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
6School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
7Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
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Garun S. Hamilton
8Dept of Lung and Sleep Medicine, Monash Health, Melbourne, Australia
9School of Clinical Sciences, Monash University, Melbourne, Australia
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Helen Tsimiklis
10Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
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Jennie Hui
11The PathWest Laboratory Medicine of West Australia, Perth, Australia
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John Burgess
1Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
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Aung K. Win
1Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
12University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Parkville, Australia
13Genetic Medicine, Royal Melbourne Hospital, Parkville, Australia
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Michael J. Abramson
6School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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E. Haydn Walters
1Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
14School of Medicine, University of Tasmania, Hobart, Australia
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Shyamali C. Dharmage
1Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
15Equal senior authors
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  • For correspondence: s.dharmage@unimelb.edu.au
Caroline J. Lodge
1Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
15Equal senior authors
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Abstract

Introduction We investigated if long-term household air pollution (HAP) is associated with asthma and lung function decline in middle-aged adults, and whether these associations were modified by glutathione S-transferase (GST) gene variants, ventilation and atopy.

Materials and methods Prospective data on HAP (heating, cooking, mould and smoking) and asthma were collected in the Tasmanian Longitudinal Health Study (TAHS) at mean ages 43 and 53 years (n=3314). Subsamples had data on lung function (n=897) and GST gene polymorphisms (n=928). Latent class analysis was used to characterise longitudinal patterns of exposure. Regression models assessed associations and interactions.

Results We identified seven longitudinal HAP profiles. Of these, three were associated with persistent asthma, greater lung function decline and % reversibility by age 53 years compared with the “Least exposed” reference profile for those who used reverse-cycle air conditioning, electric cooking and no smoking. The “All gas” (OR 2.64, 95% CI 1.22–5.70), “Wood heating/smoking” (OR 2.71, 95% CI 1.21–6.05) and “Wood heating/gas cooking” (OR 2.60, 95% CI 1.11–6.11) profiles were associated with persistent asthma, as well as greater lung function decline and % reversibility. Participants with the GSTP1 Ile/Ile genotype were at a higher risk of asthma or greater lung function decline when exposed compared with other genotypes. Exhaust fan use and opening windows frequently may reduce the adverse effects of HAP produced by combustion heating and cooking on current asthma, presumably through increasing ventilation.

Conclusions Exposures to wood heating, gas cooking and heating, and tobacco smoke over 10 years increased the risks of persistent asthma, lung function decline and % reversibility, with evidence of interaction by GST genes and ventilation.

Abstract

Long-term exposure to household air pollution (gas, wood smoke, tobacco smoke and their combinations) is linked to adverse respiratory health in middle age, particularly for those with GST risk variants and living in poorly ventilated houses https://bit.ly/3ammfKu

Footnotes

  • This article has an editorial commentary: https://doi.org/10.1183/13993003.03520-2020

  • This article has supplementary material available from erj.ersjournals.com

  • Author contributions: The authors alone are responsible for the content and writing of the article. S.C. Dharmage, E.H. Walters, M.J. Abramson, G.G. Giles and J.L. Perret were all involved with acquiring funding, data collection and/or establishing study directions and protocols. X. Dai led the analysis and interpretation of the data with support from S.C. Dharmage, C.J. Lodge, A.J. Lowe and D.S. Bui. X. Dai wrote the initial draft of the manuscript, which was critically revised for important content by all the authors. All authors approved the final version of the article.

  • Conflict of interest: X. Dai has nothing to disclose.

  • Conflict of interest: D.S. Bui has nothing to disclose.

  • Conflict of interest: J.L. Perret reports grants from the National Health and Medical Research Council of Australia and Asthma Foundation, during the conduct of the study; grants from Boehringer Ingelheim, outside the submitted work.

  • Conflict of interest: A.J. Lowe reports grants from the National Health and Medical Research Council of Australia, during the conduct of the study.

  • Conflict of interest: P.A. Frith has nothing to disclose.

  • Conflict of interest: G. Bowatte has nothing to disclose.

  • Conflict of interest: P.S. Thomas has nothing to disclose.

  • Conflict of interest: G.G. Giles has nothing to disclose.

  • Conflict of interest: G.S. Hamilton has nothing to disclose.

  • Conflict of interest: H. Tsimiklis has nothing to disclose.

  • Conflict of interest: J. Hui has nothing to disclose.

  • Conflict of interest: J. Burgess has nothing to disclose.

  • Conflict of interest: A.K. Win has nothing to disclose.

  • Conflict of interest: M.J. Abramson reports grants from Pfizer and Boehringer Ingelheim, personal fees for consultancy from Sanofi, outside the submitted work.

  • Conflict of interest: E.H. Walters has nothing to disclose.

  • Conflict of interest: S.C. Dharmage has nothing to disclose.

  • Conflict of interest: C.J. Lodge has nothing to disclose.

  • Support statement: The TAHS is supported by grants from the National Health and Medical Research Council (NHMRC) of Australia, under the NHMRC grant scheme (299901, 1021275) and NHMRC European collaborative grant scheme (1101313) as part of ALEC (Aging Lungs in European Cohorts funded by the European Union's Horizon 2020 research and innovation programme under grant agreement number 633212), the Victorian, Queensland and Tasmanian Asthma Foundations, the Clifford Craig Medical Research Trust, the Royal Hobart Hospital Research Foundation, the University of Melbourne, Helen Macpherson Smith Trust, and GlaxoSmithKline.

  • Received March 9, 2020.
  • Accepted August 7, 2020.
  • Copyright ©ERS 2021
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Exposure to household air pollution over 10 years is related to asthma and lung function decline
Xin Dai, Dinh S. Bui, Jennifer L. Perret, Adrian J. Lowe, Peter A. Frith, Gayan Bowatte, Paul S. Thomas, Graham G. Giles, Garun S. Hamilton, Helen Tsimiklis, Jennie Hui, John Burgess, Aung K. Win, Michael J. Abramson, E. Haydn Walters, Shyamali C. Dharmage, Caroline J. Lodge
European Respiratory Journal Jan 2021, 57 (1) 2000602; DOI: 10.1183/13993003.00602-2020

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Exposure to household air pollution over 10 years is related to asthma and lung function decline
Xin Dai, Dinh S. Bui, Jennifer L. Perret, Adrian J. Lowe, Peter A. Frith, Gayan Bowatte, Paul S. Thomas, Graham G. Giles, Garun S. Hamilton, Helen Tsimiklis, Jennie Hui, John Burgess, Aung K. Win, Michael J. Abramson, E. Haydn Walters, Shyamali C. Dharmage, Caroline J. Lodge
European Respiratory Journal Jan 2021, 57 (1) 2000602; DOI: 10.1183/13993003.00602-2020
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