Summary Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Tobacco smoking is established as a major risk factor, but emerging evidence suggests ...that other risk factors are important, especially in developing countries. An estimated 25–45% of patients with COPD have never smoked; the burden of non-smoking COPD is therefore much higher than previously believed. About 3 billion people, half the worldwide population, are exposed to smoke from biomass fuel compared with 1·01 billion people who smoke tobacco, which suggests that exposure to biomass smoke might be the biggest risk factor for COPD globally. We review the evidence for the association of COPD with biomass fuel, occupational exposure to dusts and gases, history of pulmonary tuberculosis, chronic asthma, respiratory-tract infections during childhood, outdoor air pollution, and poor socioeconomic status.
Summary Children seem to be most vulnerable to the harmful effects of ambient air pollutants because their defence mechanisms are still evolving and because they inhale a higher volume of air per ...body weight than adults. Air pollutants can also harm the foetus if the mother is exposed to high levels of air pollution during pregnancy. An increase in respiratory neonatal mortality has been associated with ambient levels of air pollutants. Exposure to fine particles has been shown to increase allergen sensitisation, increase the risk of worsening asthma and decrease lung function. Lung growth, as measured by lung function, seems to be adversely affected in children exposed to various oxidant air pollutants. Oxidative stress is the main underlying mechanism responsible for the harmful effects of air pollutants and preliminary studies have indicated that antioxidant supplementation can offer some protection.
The development of chronic obstructive pulmonary disease (COPD) is multifactorial, and the risk factors include both genetic and environmental factors. Although tobacco smoking is an established risk ...factor for COPD, many other associated factors remain underappreciated or neglected. Upto 50% of cases of COPD can be attributed to nonsmoking risk factors. This article describes the role of tobacco smoking and the various environmental risk factors associated with the development of COPD.
Chronic obstructive pulmonary disease (COPD) was traditionally thought to be caused by tobacco smoking. However, recognition of the importance of non-smoking-related risk factors for COPD has ...increased over the past decade, with evidence on the burden, risk factors, and clinical presentations of COPD in never-smokers. About half of all COPD cases worldwide are due to non-tobacco-related risk factors, which vary by geographical region. These factors include air pollution, occupational exposures, poorly controlled asthma, environmental tobacco smoke, infectious diseases, and low socioeconomic status. Impaired lung growth during childhood, caused by a range of early-life exposures, is associated with an increased risk of COPD. Potential mechanisms for the pathogenesis of COPD in never-smokers include inflammation, oxidative stress, airway remodelling, and accelerated lung ageing. Compared with smokers who develop COPD, never-smokers with COPD have relatively mild chronic respiratory symptoms, little or no emphysema, milder airflow limitation, and fewer comorbidities; however, exacerbations can still be frequent. Further research-including epidemiological, translational, clinical, and implementation studies-is needed to address gaps in understanding and to advance potential solutions to reduce the burden of COPD in never-smokers.
The silent epidemic of COPD in Africa Salvi, Sundeep
The Lancet global health,
2015, January 2015, 2015-Jan, 2015-01-00, 20150101, 2015-01-01, Volume:
3, Issue:
1
Journal Article
Household air pollution is a leading cause of disability-adjusted life years in Southeast Asia and the third leading cause of disability-adjusted life years globally. There are at least sixty sources ...of household air pollution, and these vary from country to country. Indoor tobacco smoking, construction material used in building houses, fuel used for cooking, heating and lighting, use of incense and various forms of mosquito repellents, use of pesticides and chemicals used for cleaning at home, and use of artificial fragrances are some of the various sources that contribute to household air pollution.
Household air pollution affects all stages of life with multi-systemic health effects, and its effects are evident right from pre-conception to old age.
In utero exposure to household air pollutants has been shown to have health effects which resonate over the entire lifetime. Exposures to indoor air pollutants in early childhood also tend to have repercussions throughout life. The respiratory system bears the maximum brunt, but effects on the cardiovascular system, endocrine system, and nervous system are largely underplayed. Household air pollutants have also been implicated in the development of various types of cancers.
Identifying household air pollutants and their health implications helps us prepare for various health-related issues. However, the real challenge is adopting changes to reduce the health effects of household air pollution and designing innovative interventions to minimize the risk of further exposure.
This review is an attempt to understand the various sources of household air pollution, the effects on health, and strategies to deal with this emergent risk factor of global mortality and morbidity.
Measuring lung function is an important component in the decision making process for patients with obstructive airways disease (OAD). Not only does it help in arriving at a specific diagnosis, but it ...also helps in evaluating severity so that appropriate pharmacotherapy can be instituted, it helps determine prognosis and it helps evaluate response to therapy. Spirometry is currently the most commonly performed lung function test in clinical practice and is considered to be the gold standard diagnostic test for asthma and COPD. However, spirometry is not an easy test to perform because the forceful expiratory and inspiratory manoeuvres require good patient co-operation. Children aged <5 years, elderly people and those with physical and cognitive limitations cannot perform spirometry easily.
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