environments and child respiratory health -...
TRANSCRIPT
TWG Respiratory
BASF AGDirk Pallapies
Univ Children's Hospital Humboldt University BERLINUlrich Wahn
UFZ Center for Environmental Research Leipzig-HalleOlf Herbarth
WHOBettina Menne
European Commisssion, DG JRCGiovanni De Santi
Europ. Commission JRCDenis Sarigiannis
Universita La Sapienza, ItalyDaniela Parola
INSERM, FranceIsabella Annesi-Maesano
IOM Edinburgh, UKAnthony Seaton
Katholieke Universiteit Leuven, BelgiumBenoit Nemery
RIVM, NetherlandsDanny Houthuijs
EEA, European Environment Agency, DenmarkDavid Gee
APAT, National Agency for Environment and Technical Services, Italy
Silvia Brini
University of Aberdeen, UKPeter Helms (co-chair)
Medical University of Silesia, PolandJan Zejda (chair)
1 Introduction
2 Childhood Respiratory Health
3 Causes - Protective factors – Triggers
4 Modifiers
5 Programs and studies underway
6 Host factors
7 Outdoor ambient exposure/ Ambient air pollution and pollen
8 Indoor exposure /Indoor environmental risk factors
9 Gaps in knowledge
10 Recommendations
11 Conclusions
2 Introduction to Childhood Respiratory Health
2.1 Context
2.2 Temporal changes
2.3 Impact of therapy
2.4 Geographical variation
2.5 Multi-causality
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3 Causes - Protective factors – Triggers3.1 Causes and triggers3.2 Definitions4 Modifiers4.1 Preamble4.2 Host susceptibility4.2.1 Genetics4.2.2 Gene/environmental interactions4.3 Gender4.4 Age/developmental stage4.4.1 Fetal programming of lung disease in children and adults4.4.2 Lung Development and Implications for disease4.4.3 Unique vulnerabilities4.5 Ethnic groups/Social deprivation
Table of ongoing/major or relevant studies on respiratory health
Study name
Population (description and number)
Age of population Design study/type
Country/Region Exposure factor
Beginning date
End date (expected) Contact person Responsible organis
ASMAasthmatic children (n~400)
6-12 years old cross sectional France smoking 1995 Prof. Dr. R. Liard INSERM Paris
BAMSEnewborn (n~4000) cohort Sweden
social factors, indoor climate 1994
Prof. Dr. M. Wickmann
Env. Health Stockholm CCouncil
LISAnewborn (n~2000) cohort Germany
VOC, bioaerosols, TSP and PM 1998 2006
Prof. Dr. O. Herbarth, Prof. Dr. H.-E. Wichmann
UFZ-Centre Environmental ResGSF-Environm. Health Research Ce
LEIPI clinical cases 0-18 intervention study Germany mould 1999 2005Prof. Dr. O. Herbarth, Prof. Dr. G. Metzner
UFZ-Centre Environmental Resand University of L
KIGA & KIGA-ENV
kindergarten children (n~1200) 6 cross sectional
Germany and Argentina VOC, TSP and PM, PAH 1993 2005 Prof. Dr. O. Herbarth
UFZ and UniveMendoza Universidad La Plat
LARSnewborn (at risk) (n~475) cohort Germany indoor exposure 1995 2004
Prof. Dr. O. Herbarthand PD Dr. M. Borte
UFZ-Centre Environmental Resand University of L
LISSschool children (n~3500) 6 and 8
repeated cross sectional Germany
indoor related activities, infection 1997 2005 Prof. Dr. O. Herbarth
UFZ-Centre Environmental Rese
6 Host factors
6.1 Infections
6.2 Asthma and Atopy
6.2.1 The Hygiene hypothesis
6.2.2 Diet
6.2.3 In utero and infant environment
7 Outdoor ambient exposure/ Ambient air pollution and pollen
7.1 Introduction
7.2 Ambient air pollution in Europe
7.3 Respiratory health effects of exposure to ambient air pollution
7.4 Respiratory health effects of exposure to pollen
region 6-7 years old children 13-14 years old children
Wheezing Hay fever Asthma Wheezing Hay fever Asthma
North and Eastern Europe 7.3-10.9 0.9-7.5 1.6-8.0 8.1-16.0 3.9-27.4 2.4-10.4
Central and Western Europe 7.2-18.4 2.9-10.6 2.9-22.9 11.6-32.2 11.7-34.8 4.2-20.7
Southern Europe 6.2-13.2 5.3-9.3 5.4-11.0 3.7-10.3 5.9-15.8 4.5-12.1
Data are from ISAAC 1998 expressed as % prevalence ranges.
8 Indoor exposure /INDOOR ENVIRONMENTAL RISK FACTORS
8.1 Exposure scenarios
8.2 Exposure
8.2.1 Home Environment
8.2.2 The School environment
8.2.3 Other indoor environments
GAPS IN KNOWLEDGE
•Constituents of the indoor environment. Focus on new building materials and
agents used within the home.
•Interaction between external and internal (home) environments.
•European definitions of chronic childhood respiratory symptoms particularly
bronchitis and asthma.
•Evidence based reviews of relevant environmental hazards.
•Important gene/environmental interactions and susceptible population sub
groups.
•Medium to long term effects of exposures for respiratory health (Birth and
child cohorts).
•Effects of exposure to indoor and outdoor air pollution at different stages of
development.
RECOMMENDATIONS(Research needs)
• Biomarkers & methods for risk assessment• Genes and disease risk• Genes and susceptibility to exposures• Medium/long term consequences of
exposure