Indoor Combustion and Asthma

doi:10.1016/j.iac.2008.03.011

Immunology and Allergy Clinics of North America

Volume 28, Issue 3, August 2008, Pages 507-519

https://doi.org/10.1016/j.iac.2008.03.011 Get rights and content

Indoor combustion produces both gases (eg, nitrogen dioxide, carbon monoxide) and particulate matter that may affect the development or exacerbation of asthma. Sources in the home include both heating devices (eg, fireplaces, woodstoves, kerosene heaters, flued [ie, vented] or nonflued gas heaters) and gas stoves for cooking. This article highlights the recent literature examining associations between exposure to indoor combustion and asthma development and severity. Since asthma is a chronic condition affecting both children and adults, both age groups are included in this article. Overall, there is some evidence of an association between exposure to indoor combustion and asthma, particularly asthma symptoms in children. Some sources of combustion such as coal stoves have been more consistently associated with these outcomes than other sources such as woodstoves.

Section snippets

Woodstoves

Wood smoke includes a vast array of constituents forming a complex mix of particles of varying chemical and physical composition, making it difficult to identify any individual harmful constituent [4]. Thus, some have argued that it is best to examine the entire mixture rather than its individual constituents [4]. Factors such as frequency of use, whether the woodburning stove is a primary or secondary heater, ventilation, age, type and condition of the device, and size of home influence

Gas cooking stoves

Gas cooking stoves are an important source of indoor NO₂. However, gas stoves tend to be used for shorter periods of time and are limited to the kitchen, resulting in a strong spatial gradient within the home. A large number of studies have investigated the relationship between gas cooking stoves and asthma prevalence or asthma symptoms. Both adults and children have been studied. Results are inconsistent, but exposure of children appears to be more consistent with risk than exposure of adults.

Discussion

This article did not find any studies that addressed the question of an association between indoor combustion and asthma incidence. To examine this question would require a cohort followed from birth. However, several studies considered increased asthma prevalence in association with combustion sources. Eight studies reported positive associations for asthma prevalence among children [9], [11], [12], [14], [15], [16], [25], [29]; two studies reported negative findings [22], [23]. Among adults,

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Cited by (48)

Gas cooking and respiratory outcomes in children: A systematic review
2023, Global Epidemiology
The most recent meta-analysis of gas cooking and respiratory outcomes in children was conducted by Lin et al. [93] in 2013. Since then, a number of epidemiology studies have been published on this topic. We conducted the first systematic review of this epidemiology literature that includes an in-depth evaluation of study heterogeneity and study quality, neither of which was systematically evaluated in earlier reviews. We reviewed a total of 66 relevant studies, including those in the Lin et al. [93] meta-analysis. Most of the studies are cross-sectional by design, precluding causal inference. Only a few are cohort studies that could establish temporality and they have largely reported null results. There is large variability across studies in terms of study region, age of children, gas cooking exposure definition, and asthma or wheeze outcome definition, precluding clear interpretations of meta-analysis estimates such as those reported in Lin et al. [93]. Further, our systematic study quality evaluation reveals that a large proportion of the studies to date are subject to multiple sources of bias and inaccuracy, primarily due to self-reported gas cooking exposure or respiratory outcomes, insufficient adjustment for key confounders (e.g., environmental tobacco smoke, family history of asthma or allergies, socioeconomic status or home environment), and unestablished temporality. We conclude that the epidemiology literature is limited by high heterogeneity and low study quality and, therefore, it does not provide sufficient evidence regarding causal relationships between gas cooking or indoor NO₂ and asthma or wheeze. We caution against over-interpreting the quantitative evidence synthesis estimates from meta-analyses of these studies.
The gas stove-childhood asthma kerfuffle: A teaching opportunity
2023, Global Epidemiology
Several recent news stories have alarmed many politicians and members of the public by reporting that indoor air pollution from gas stoves causes about 13% of childhood asthma in the United States. Research on the reproducibility and trustworthiness of epidemiological risk assessments has identified a number of common questionable research practices (QRPs) that should be avoided to draw sound causal conclusions from epidemiological data. Examples of such QRPs include claiming causation without using study designs or data analyses that allow valid causal inferences; generalizing or transporting risk estimates based on data for specific populations, time periods, and locations to different ones without accounting for differences in the study and target populations; claiming causation without discussing or quantitatively correcting for confounding, external validity bias, or other biases; and not mentioning or resolving contradictory evidence. We examine the recently estimated gas stove-childhood asthma associations from the perspective of these QRPs and conclude that it exemplifies all of them. The quantitative claim that about 13% of childhood asthma in the United States could be prevented by reducing exposure to gas stove pollution is not supported by the data collected or by the measures of association (Population Attributable Fractions) used to analyze the data. The qualitative finding that reducing exposure to gas stove pollution would reduce the burden of childhood asthma in the United States has no demonstrated validity. Systematically checking how and whether QRPs have been addressed before reporting or responding to claims that everyday exposures cause substantial harm to health might reduce social amplification of perceived risks based on QRPs and help to improve the credibility and trustworthiness of published epidemiological risk assessments.
Charcoal burning is associated with a higher risk of delayed neurological sequelae after domestic carbon monoxide poisoning in South China: A retrospective cohort study
2022, American Journal of Emergency Medicine
Citation Excerpt :
Third, charcoal burning releases many gases, such as carbon dioxide, CO, sulfur dioxide (SO2), and other harmless gases. However, gas-emitting heaters mainly emit carbon dioxide and CO, while other harmful gases are emitted at much lower levels than charcoal burning [19,28]. Some studies have found that SO2 exposure could accelerate hypoxia and induce brain impairment [14,29].
Delayed neurological sequelae (DNS) are a severe complication of carbon monoxide poisoning (COP) and high predisposing rates of disability and mortality, yet the relationship between exposure factors and DNS remains unknown. The aim was to investigate the association between domestic sources of COP and DNS.
Patients diagnosed with COP between December 2016 and November 2021 were included and divided into two groups according to their sources of poisoning and the endpoint outcome was analyzed by logistic regression before and after propensity score matching (PSM).
Overall, medical data from 314 patients were analyzed. In multivariate logistic regression, advanced age (adjusted odds ratio (AOR): 1.028, 95% CI: 1.008–1.049, P = 0.007), longer duration of exposure to the first treatment of hyperbaric oxygen (HBO) (AOR: 1.081, 95% CI: 1.036–1.127, P = 0.001), and intoxication by charcoal burning (AOR: 3.24, 95% CI: 1.208–8.69, P = 0.019) were associated with a higher risk of developing DNS. After 1:1 PSM, the outcomes also revealed that charcoal burning intoxication (odds ratio (OR): 8.396, 95% CI: 3.342–21.095, P<0.001) was associated with greater odds of DNS.
This study indicates that domestic COP caused by charcoal burning is more likely to trigger DNS than gas-emitting heaters.
Exposure to biomass fuel is associated with high blood pressure and fasting blood glucose impairment in females in southern rural China
2021, Environmental Research
Citation Excerpt :
There were some interpretations for these discrepancies. The HAP resulting from cooking and heating is a known risk factor for the adverse health effects in developing countries, but less of a problem in developed countries (Belanger and Triche, 2008; Zheng et al., 2020). The frequency of usage, the type of biomass fuel, the ventilating conditions and the population density might have accounted for the different magnitude of adverse effects (Papakonstantinou et al., 2015).
We sought to investigate the association between household exposure to biomass fuel and metabolic syndrome (MetS) and its components including blood pressure, triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG) and waist circumference among females in southern rural China.
We surveyed 1664 residents in the Chronic Disease and Risk Factors Surveillance, conducted in 14 districts of Guangdong province. We recorded the use of biomass fuel, MetS and its components, and other covariates by using a structured questionnaire. Logistic regression model and multivariate linear regression model were adopted for analysis.
Exposure to biomass fuel was significantly associated with an increase of systolic blood pressure (SBP) (β: 2.15, 95% confidence interval: 0.13 to 4.17) and FBG (β: 0.19, 95% confidence interval: 0.01 to 0.37) in the adjusted and unadjusted models (all P < 0.05). Among participants with exposure to biomass fuel, being overweight or obese was associated with an increased risk of having hypertension (odds ratio: 3.19, 95% confidence interval: 2.13 to 4.76) and higher FBG levels (odds ratio: 2.10, 95% confidence interval: 1.46 to 3.02). Exposure to biomass fuel was significantly associated with a decrease of the prevalence of central obesity (P < 0.05). However, exposure to biomass fuel was not associated with MetS, diastolic blood pressure and TG (all P > 0.05).
Exposure to biomass fuel is associated with an increase in blood pressure and FBG levels, but not MetS per se. Efforts should be made to protect females in southern rural China from the adverse effects associated with biomass fuel pollution.
Indoor air quality in residential buildings in Upper Silesia, Poland
2020, Building and Environment
This paper presents the results of measurements of carbon dioxide (CO₂), BTESX (benzene, toluene, ethylbenzene, styrene, and xylenes), nitrogen dioxide (NO₂)_, and particulate matter with aerodynamic diameter ≤4 μm (PM₄) during the winter season in the Upper Silesia region, Poland. The samples were collected simultaneously outside and inside residential buildings (flats and houses), including kitchens, living rooms, and bedrooms. Concentrations of CO₂ were measured automatically, PM₄, gravimetrically, while BTESX and NO₂ were collected by passive methods and determined by gas chromatography (GC) and spectrophotometry, respectively. The highest CO₂ concentrations were found in bedrooms (mean value 857 ± 217 ppm), pointing to a small volume of this type of room. Toluene had the highest concentration among studied volatile organic compounds (VOCs), with the max. values 135.46 and 77.11 μg/m³ in flats and houses, respectively. Elevated concentrations of BTESX indoors (63.7 ± 39.6, 57.0 ± 32.7 and 67.7 ± 48.4 μg/m³ in bedrooms, kitchens and living rooms, respectively) point to the significant role of renovation works in flats, particularly the use of Styrofoam, as well as poor ventilation of garages located in houses. Increased NO₂ concentrations (20.5 ± 6.5, 24.9 ± 13.2 and 21.2 ± 10.9 μg/m³ in bedrooms, kitchens and living rooms, respectively) were observed with intensive use of gas cookers; however, no exceedances of the accepted levels were reported. Results indicate that occupants in studied buildings are particularly exposed to high PM₄ levels from 26.1 to 314.9 μg/m³ associated with infiltration from outdoor air, which can be dangerous for their health.
Traffic-related air pollution and the local burden of childhood asthma in Bradford, UK
2019, International Journal of Transportation Science and Technology
Citation Excerpt :
In recent years, the number of epidemiological studies investigating various environmental exposures that can modify the risk of asthma has grown substantially. These exposures include, but are not limited to, exposure to domestic pets (Almqvist et al., 2003; Apelberg et al., 2001; Carlsten et al., 2010; Dong et al., 2009), exposure to allergens, including animal, mouse, rat, cockroach, house dust mite, fungal, tree and weed antigens (Arshad, 2010; Arshad et al., 2002; Barnes et al., 2001; Breysse et al., 2010; Byrd and Joad, 2006; Carrer et al., 2001; Chen et al., 2011), exposure to parental and especially maternal tobacco smoke (Gilmour et al., 2006; Gilliland et al., 2001; Arruda et al., 2005; Chen et al., 2011; Chhabra et al., 1999), and exposure to indoor and outdoor air pollution (Belanger and Triche, 2008; Breysse et al., 2010; Khreis et al., 2017). From this list, we focus on exposure to outdoor air pollution.
Asthma is a burdensome disease which is often cited as the most common chronic disease in childhood. Traffic-related air pollution (TRAP) may be an important exposure in the development of childhood asthma. However, the burden of childhood asthma attributable to TRAP is poorly documented. Using a land-use regression (LUR) model, we estimated the childhood (birth-18 years old) population exposure to the following three air pollutants in Bradford, UK: Particulate Matter equal or less than 2.5 micrometers in diameter (PM_2.5), Particulate Matter equal or less than 10 micrometers in diameter (PM₁₀) and Black Carbon (BC). We assigned exposures at the lowest census tract level: the ‘output area’. We extracted national and local childhood asthma incidence rates from the literature and used meta-analytic exposure-response functions to calculate the relative risk, population attributable fraction of childhood asthma in association with each pollutant and the number of childhood asthma cases attributable to each pollutant. We investigated the impacts of reducing air pollutants at each output area to comply with the World Health Organization’s (WHO) air quality guidelines. At the output area level, the annual mean PM_2.5, PM₁₀ and BC concentrations were 10.40 µg/m³, 16.63 µg/m³ and 1.07 × 10⁻⁵ m⁻¹, respectively. Depending on the pollutant, the estimated number of attributable childhood asthma cases varied between 279 and 612 annually, representing between 15% and 33% of all cases in the city. Between 7% and 12% of annual childhood asthma cases were specifically attributable to TRAP. Compliance with the WHO air quality guidelines prevented up to 29 cases. Using national versus local baseline childhood asthma incidence rates with differing underlying asthma definitions resulted in up to 322% as many attributable cases. Air pollution is estimated to cause a large, but preventable, childhood asthma burden. The burden of disease varied depending on the pollutant selected.

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: Supported by grants ES05410 and ES011013 from the National Institute of Environmental Health Sciences.

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Indoor Combustion and Asthma

Section snippets

Woodstoves

Gas cooking stoves

Discussion

Indoor environment and respiratory symptoms in children living in the Dutch-German borderland

Int J Hyg Environ Health

Synthesis of environmental evidence: Nitrogen dioxide epidemiology studies

J Air Waste Manag Assoc

Randomized controlled trial of unflued gas heater replacement on respiratory health of asthmatic schoolchildren

Int J Epidemiol

Woodsmoke health effects: a review

Inhal Toxicol

Adult-onset asthma is associated with self-reported mold or environmental tobacco smoke exposures in the home

Allergy

Wood stove heating, asthma and allergies

Respir Med

Exposure to indoor combustion and adult asthma outcomes: environmental tobacco smoke, gas stoves, and woodsmoke

Thorax

Environmental tobacco smoke, woodstove heating and risk of asthma symptoms

J Asthma

Home heating and respiratory symptoms among children in Belfast, Northern Ireland

Arch Environ Health

Symptoms of asthma and the home environment. The ISAAC I and III cross-sectional surveys in Munster, Germany

Int Arch Allergy Immunol

Childhood asthma in Beijing, China: a population-based case-control study

Am J Epidemiol

Factor analysis of household factors: are they associated with respiratory conditions in Chinese children?

Int J Epidemiol

Air quality criteria for oxides of nitrogen

The relation between infant indoor environment and subsequent asthma

Epidemiology