Iolanda Caires

Airways changes related to air pollution exposure in wheezing children

In this study, we aimed to evaluate the relationship between individual total exposure to air pollution and airway changes in a group of 51 wheezing children. Respiratory status was assessed four times (January 2006, June 2006, January 2007 and June 2007) during a 1-week period through a standardised questionnaire, spirometry, exhaled nitric oxide fraction and pH in exhaled breath condensate (EBC). Concentrations of particles with a 50% cut-off aerodynamic diameter of 10 µm (PM10), O3, NO2 and volatile organic compounds were estimated through direct measurements with an ad hoc device or air pollution modelling in the childrens schools and at their homes in the same 4 weeks of the study. For each child, total exposure to the different air pollutants was estimated as a function of pollutant concentrations and daily activity patterns. Increasing total exposure to PM10, NO2, benzene, toluene and ethylbenzene was significantly associated with a decrease of forced expiratory volume in 1 s (FEV1) and with an increase of change in FEV1. Increasing exposure to NO2 and benzene was also related to a significant decrease of FEV1/forced vital capacity. Increasing exposure to PM10, NO2, benzene and ethylbenzene was associated with acidity of EBC. This study suggests an association in wheezing children between airway changes and total exposure to air pollutants, as estimated by taking into account the concentration in the various microenvironments attended by the children.

Chronic respiratory diseases and quality of life in elderly nursing home residents

Few studies have assessed the quality of life (QOL) related to chronic respiratory diseases in the elderly. In the framework of the geriatric study on the health effects of air quality in elderly care centers (GERIA) study, a questionnaire was completed by elderly subjects from 53 selected nursing homes. It included various sections in order to assess respiratory complaints, QOL (World Health Organization QOL (WHOQOL)-BREF), and the cognitive and depression status. The outcome variables were the presence of a score lower than 50 (<50) in each of the WHOQOL-BREF domains (physical health, psychological health, social relationships, and environmental health). Chronic bronchitis, frequent cough, current wheezing, asthma, and allergic rhinitis were considered as potential risk factors. The surveyed sample was (n = 887) 79% female, with a mean age of 84 years (SD: 7 years). In the multivariable analysis, a score of <50 in the physical domain was associated with wheezing in the previous 12 months (odds ratio (OR): 2.03, confidence interval (CI): 1.25–3.31) and asthma (OR: 1.95, CI: 1.12–3.38). The psychological domain was related with a frequent cough (OR: 1.43, CI: 0.95–2.91). A score of <50 in the environmental domain was associated with chronic bronchitis (OR: 2.89, CI: 1.34–6.23) and emphysema (OR: 3.89, CI: 1.27–11.88). In view of these findings, the presence of respiratory diseases seems to be an important risk factor for a low QOL among elderly nursing home residents.

Effect of indoor air quality of day care centers in children with different predisposition for asthma

Scarce information is available about the relationships between indoor air quality (IAQ) at day care centers (DCC), the estimated predisposition for asthma, and the actual wheezing susceptibility.

The impact of indoor air quality and contaminants on respiratory health of older people living in long-term care residences in Porto

BACKGROUND persons who are 65 years or older often spend an important part of their lives indoors thus adverse indoor climate might influence their health status. OBJECTIVE to evaluate the influence of indoor air quality and contaminants on older peoples respiratory health. DESIGN cross-sectional study. SETTING 21 long-term care residences (LTC) in the city of Porto, Portugal. SUBJECTS older people living in LTC with ≥65 years old. METHODS the Portuguese version of BOLD questionnaire was administered by an interviewer to older residents able to participate (n = 143). Indoor air contaminants (IAC) were measured twice, during winter and summer in 135 areas. Mixed effects logistic regression models were used to study the association between the health questionnaire results and the monitored IAC, adjusted for age, smoking habits, gender and number of years living in the LTC. RESULTS cough (23%) and sputum (12%) were the major respiratory symptoms, and allergic rhinitis (22%) the main self-reported illness. Overall particulate matter up to 2.5 micrometres in size median concentration was above the reference levels both in winter and summer seasons. Peak values of particulate matter up to 10 micrometres in size (PM10), total volatile organic compounds, carbon dioxide, bacteria and fungi exceeded the reference levels. Older people exposed to PM10 above the reference levels demonstrated higher odds of allergic rhinitis (OR = 2.9, 95% CI: 1.1-7.2). CONCLUSION high levels of PM10 were associated with 3-fold odds of allergic rhinitis. No association was found between indoor air chemical and biological contaminants and respiratory symptoms.

Individual Exposure to Air Pollutants in a Portuguese Urban Industrialized Area

Industrial development from the second half of the 20th century coupled with population growth and concentration in urban areas has accentuated the concern for potential effects and impacts from air pollutant emissions on environmental and human health. This study examined the Estarreja region, an urban area that has one of the largest chemical complexes in Portugal, a complex that was recently under expansion. In the scope of the INSPIRAR project, individual daily exposure of a group of individuals to particulate matter of 10 μm aerodynamic diameter (PM10) and nitrogen dioxide (NO2) in two phases was determined using a microenvironmental approach. In this context, personal daily activity profiles of individuals were established for their normal routine by personal interviews. These profiles enabled determination of where each individual was at each moment of the day. Utilizing this information with hourly air quality maps simulated with URBAIR air quality model and indoor/outdoor relationships, it was possible to calculate personal daily exposure of each individual to air pollutants. Results from the analysis of daily activity profiles showed a high level of sedentariness of this population and long durations spent indoors. The studied individuals displayed high personal PM10 and NO2 exposure variability. Data demonstrated possible error when a single concentration measurement was assumed as a proxy of exposure. In general, no significant differences were found between the two population groups, indicating that workers of the chemical complex were not exposed to a greater extent to PM10 and NO2 than the general population working in the same area.

The Influence of Thermal Comfort on the Quality of Life of Nursing Home Residents

ABSTRACT Thermal comfort (TC) parameters were measured in 130 rooms from nursing homes (NH), following ISO 7730:2005 in order to evaluate the influence of winter season TC indices on quality of life (QoL) in older individuals. Mean radiant temperature (mrT), predicted mean vote (PMV) and predicted percent of dissatisfied people (PPD) indices, and the respective measurement uncertainties were calculated using Monte Carlo Method. The WHOQOL-BREF questionnaire was conducted from September 2012 to April 2013, during the winter season TC sampling campaign. Winter PMV and PPD indices showed significant differences between seasons in median values for comfort. There were also significant differences between seasons for air temperature, air velocity, mrT, and relative humidity. The winter PMV index displayed a “slightly cool” [≤−1] to “cool” [≤−2] in thermal sensation scale [−3 to 3]. PPD index reflected this discomfort as evidenced by a high rate of predicted dissatisfied occupants (64%). The influence of winter season TC on older individual QoL results demonstrated that values of PMV above −0.7 had higher mean score of QoL (coefficient estimate: 11.13 units) compared with values of PMV below −0.7. These findings are of relevance to public health and may be useful for understanding NH indoor environment variables thus implementing preventive policies in terms of standards and guidelines for these susceptible populations.

Food Allergy and Anaphylaxis in Infants and Preschool-Age Children

Food allergy (FA) prevalence data in infants and preschool-age children are sparse, and proposed risk factors lack confirmation. In this study, 19 children’s day care centers (DCC) from 2 main Portuguese cities were selected after stratification and cluster analysis. An ISAAC’s (International Study of Asthma and Allergies in Childhood) derived health questionnaire was applied to a sample of children attending DCCs. Outcomes were FA parental report and anaphylaxis. Logistic regression was used to explore potential risk factors for reported FA. From the 2228 distributed questionnaires, 1217 were included in the analysis (54.6%). Children’s median age was 3.5 years, and 10.8% were described as ever having had FA. Current FA was reported in 5.7%. Three (0.2%) reports compatible with anaphylaxis were identified. Reported parental history of FA, personal history of atopic dermatitis, and preterm birth increased the odds for reported current FA. A high prevalence of parental-perceived FA in preschool-age children was identified. Risk factor identification may enhance better prevention.

Respiratory infections in elderly people: Viral role in a resident population of elderly care centers in Lisbon, winter 2013–2014

Abstract Objective The aim of this study was to analyze the etiology and clinical consequences of viral respiratory infections in 18 elderly care centers (ECC) in Lisbon, which housed a total of 1022 residents. Methods Nasopharyngeal swabs were collected whenever an elderly had symptoms of acute respiratory infections (ARI). PCR and RT-PCR were performed for influenza A/B, human parainfluenza virus 1–4, adenovirus, human metapneumovirus (HMPV), respiratory syncytial virus (RSV), rhinovirus, enterovirus, human coronavirus and human Bocavirus (HBoV). Array cards for atypical bacteria were also used in severe cases. Results In total, 188 episodes of ARI were reported, being rhinovirus the most frequently detected (n=53), followed by influenza A(H3) (n=19) and HBoV (n=14). Severe infections were reported in 19 patients, 11 of which were fatal, Legionela pneumophila, rhinovirus, HMPV and RSV associated with these fatalities. Nine influenza strains were analyzed, all antigenically dissimilar from vaccine strain 2013/14. “Age”, “HMPV” and “Respiratory disease” showed an association with severe infection. Conclusions In this study an etiologic agent could be found in 60% of the acute respiratory episodes. These data provides information about the circulating viruses in ECC and highlights the importance of searching both viruses and atypical bacteria in severe ARI.

Respiratory diseases in children attending kindergartens: Health-related variables and mothers’ psychological, parental, and marital functioning

This study aimed to examine the differences between mothers of children with and without respiratory problems in variables related to psychological, parental, and marital functioning and to determine which contributed more to parenting stress, because there is a lack of information in this field. Participants were 459 mothers of children attending kindergartens, who accepted to participate. The instruments were The International Study of Asthma and Allergies in Childhood questionnaire, Hospital Anxiety and Depression Scale, Parenting Stress Index–Short Form, Parenting Stress Index–Long Form, and Escala de Avaliação da Satisfação em Áreas da Vida Conjugal. Anxiety, depression, and parenting stress were higher in the more symptomatic children and parenting stress was associated with anxiety, depression, and marital satisfaction. Findings support the relevance of children’s respiratory-related variables to mothers’ psychological, parental, and marital functioning.