Environments and Child Respiratory Health

Peter J Helms (chair)

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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Multi-causality Framework for Environment and Health

Genes Host Conditions

Exposure

Effects

Harm

Exposures in context

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

5 Programs and studies underway5.1 European programmes/ studies

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

9 Gaps in knowledge

10 Recommendations

11 Conclusions

12 References

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 (General)

• Consider the Multicausality model

RECOMMENDATIONS(Research needs)

• Biomarkers & methods for risk assessment• Genes and disease risk• Genes and susceptibility to exposures• Medium/long term consequences of

exposure

RECOMMENDATIONS(for action)

• Susceptibility (genetic?) and intelligent cost effective interventions

• Evidence for public health actions egEnvironmental tobacco smoke/Clean air