Non-communicable respiratory disease and air pollution exposure in Malawi: a prospective cohort study
Non-communicable respiratory disease and air pollution exposure in Malawi: a prospective cohort study
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DOI：
10.1136/thoraxjnl-2019-213941
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发表时间：
2020-03-01
期刊：
影响因子：
10
通讯作者：
Mortimer, Kevin
中科院分区：
文献类型：
--
作者：
Rylance, Sarah;Jewell, Chris;Mortimer, Kevin
基本原理 撒哈拉以南非洲地区尚无描述成人纵向肺功能的基于人群的研究。目标 探索生活在马拉维农村的成年人的肺功能轨迹及其决定因素，包括空气污染暴露和烹饪与肺炎研究 (CAPS) 中清洁燃烧生物质燃料炉灶干预的影响。方法 我们评估了呼吸道症状和暴露情况、肺量测定法，并测量了 48 小时个人接触细颗粒物的情况(PM 2.5) 和一氧化碳 (CO)，3 年内 3 次。使用最大似然估计的混合效应模型对纵向数据进行分析。测量和主要结果我们招募了 1481 名成年人，平均 (SD) 年龄为 43.8 (17.8) 岁，其中包括来自 CAPS 家庭的 523 名参与者（271 名干预组；252 名对照），并分别收集了 654 名（44%）和 929 名（63%）人的多项肺量测定和空气污染测量结果。与全球肺功能倡议非裔美国人参考范围相比，平均 (SD) FEV 1（1 秒用力呼气量）和 FVC（用力肺活量）z 分数分别为 -0.38 (1.14) 和 -0.19 (1.09)。 FEV 1 和 FVC 由年龄、性别、身高、既往结核病和体重指数决定，FEV 1 每年下降 30.9 mL（95% CI：21.6 至 40.1），FVC 每年下降 38.3 mL（95% CI：28.5 至 48.1）。使用炉灶的人接触 PM 2.5 的情况有所减少，但对肺功能没有影响。 结论 与高收入国家健康、不吸烟人群的报告相比，我们没有观察到这组马拉维成年人的肺功能加速下降；这表明我们在成年时测量的肺功能缺陷可能起源于生命早期。
Rationale There are no population-based studies from sub-S aharan Africa describing longitudinal lung function in adults.Objectives To explore the lung function trajectories and their determinants, including the effects of air pollution exposures and the cleaner-burning biomass-fuelled cookstove intervention of the Cooking and Pneumonia Study (CAPS), in adults living in rural Malawi.Methods We assessed respiratory symptoms and exposures, spirometry and measured 48-hour personal exposure to fine particulate matter (PM 2.5) and carbon monoxide (CO), on three occasions over 3 years. Longitudinal data were analysed using mixed-effects modelling by maximum likelihood estimation.Measurements and main results We recruited 1481 adults, mean (SD) age 43.8 (17.8) years, including 523 participants from CAPS households (271 intervention; 252 controls), and collected multiple spirometry and air pollution measurements for 654 (44%) and 929 (63%), respectively. Compared with Global Lung Function Initiative African-A merican reference ranges, mean (SD) FEV 1 (forced expiratory volume in 1 s) and FVC (forced vital capacity) z-scores were -0.38 (1.14) and -0.19 (1.09). FEV 1 and FVC were determined by age, sex, height, previous TB and body mass index, with FEV 1 declining by 30.9 mL/year (95% CI: 21.6 to 40.1) and FVC by 38.3 mL/year (95%CI : 28.5 to 48.1). There was decreased exposure to PM 2.5 in those with access to a cookstove but no effect on lung function.Conclusions We did not observe accelerated lung function decline in this cohort of Malawian adults, compared with that reported in healthy, non-smoking populations from high-income countries; this suggests that the lung function deficits we measured in adulthood may have origins in early life.