Joana Madureira, Inês Paciência, Elisabete Ramos, C ristiana Pereira, João P. Teixeira, Gabriela Ventura, Eduardo O. Fernandes, H enrique Barros
Unit of Advanced Studies in Energy in the Built EnvironmentIDMEC-FEUP
Porto, Portugal
Adverse respiratory effects ofindoor air pollution
July 7-12 2014, Hong Kong
Wednesday, July 09, 2014(A6) Health and indoor air epidemiology
Contents
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1. Objective
2. Participants and Methods
3. Results and Discussion
4. Conclusions
2. Objective
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To evaluate the association between indoorair exposure and primary school children ´srespiratory symptoms .
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Cross-Sectional Study
- Building/classroom inspectionchecklist
- Time-activity diary- IAQ measurements
- Health questionnaire- Clinical health examination
Heating Season Nov. 2011-Dec. 2012
• Health assessment (n=1099 participants)
3. Participants and Methods
Monday � Friday
• Environmental audit (n=63 classrooms)
3. Participants and Methods
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Parents’ questionnaire
Lung function test
1639 eligible children (8-9 yrs old)(20 schools, 73 classrooms)
n=1099
324 (19.8%)never reply
978 childrenStudy of the associations between IAQ and ISAAC
symptoms (wheeze, nasal allergy, cough and phlegm
episodes).
181 (11.0%)refused
846 childrenStudy of the associations between IAQ and recent symptoms-past 3 months (hand rash or face rash, eczema, eye irritation, runny nose or blocked nose, irritative cough).
1134 (69.2%)participated
n=842
Health Assessment
3. Participants and Methods
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Checklist Time-activity diary
Walkthrough inspection and checklist
Environmental Audit - Survey
4. Collect, evaluate and report results
2. Design study3. Suitable
analysis methods
1. Define monitoring objective *
Conclusions
Recommendations
Statistical evaluation
Quality control of the data
Health complaint
Remediation effectiveness
Guideline compliance
Source attribution
Survey
*Differ in the amountand specificity of therequirements
Results and discussion
Specific objective
Choose sampling strategy and procedure
Identify substances of concern
Identify monitoring sites
Identify data requirements
Visiting inspection
Identify information to record
Define data quality objectives
Choose analytical method
Execute analytical method
Define and apply QA/QC standards
Uncertainty estimation
3. Participants and Methods
3. Participants and Methods
Volatile organic compounds (1)
Formaldehyde, acetaldehyde (2)
CO (3)
-sampling: stainless-steel tubes containing Tenax®
TA-analyses: GC/MS, ISO 16000-6
-sampling: passive samplers RAD165-analyses: HPLC with UV detector, ISO 16000-4
-electrochemical sensor(equiment with datalogger)
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IAQ measurementsSampling: - passive: 1 week
- active: 8/24 hours
(1) (2) (3)
Environmental Audit - Survey
3. Participants and Methods
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TSA
MEA
CO2 (1)
Temperature & relative humidity (1)
PM2.5, PM10 (2)
Bacteria & fungi (3)
-infrared non-dispersive sensor-thermistor and thin-film capacitive sensor
-laser photometers based on optical light scattering (equiment with datalogger)
-sampling: single-stage microbiological air impactor + agar plates-analysis: NIOSH 0800, ISO 13098
Sampling active: 8/24 hours
(2) (3)(1)
IAQ measurementsEnvironmental Audit - Survey
n>DL Mean SD Median P25 P75 Min Max
Chemical
Benzene, µg/m3 7 2.16 0.49 2.47 1.58 2.60 1.48 2.67
Toluene, µg/m3 72 15.10 34.50 6.37 4.49 10.40 1.84 202.50
m/p-xylene, µg/m3 71 17.70 59.00 4.97 3.31 6.82 1.21 365.20
o-xylene, µg/m3 68 3.93 6.92 2.30 1.83 3.37 1.09 52.40
d-limonene, µg/m3 71 38.10 44.50 23.10 11.50 48.60 2.77 215.30
α-pinene, µg/m3 63 3.40 5.50 1.75 1.32 2.75 1.01 32.00
T4CE, µg/m3 18 2.90 1.53 2.90 1.77 3.39 1.07 8.25
Naphthalene, µg/m3 6 1.40 0.21 1.33 1.24 1.60 1.15 1.68
Styrene, µg/m3 13 1.41 0.46 1.19 1.17 1.35 1.02 2.66
TVOC, µg/m3 73 172.20 145.20 140.30 85.5 198.40 8.88 820.20
Formaldehyde, µg/m3 73 19.80 10.90 17.50 13.80 23.10 8.24 126.90
Acetaldehyde, µg/m3 73 9.31 7.82 7.65 4.96 10.4 1.92 64.60
CO, mg/m3 -- 0.48 0.44 0.38 0.07 0.68 0.01 1.70
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4. Results and Discussion
DL- detection limit; CO concentrations corresponds to the teaching hours
Chemical parameters bellow existing WHOguidelines and INDEX recommendations values.
Chemical parameters in classrooms ( n=73)
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4. Results and Discussion
Mean SD Median P25 P75 Min Max
Physical and comfort
PM2.5, µg/m3 94 40 82 67 106 39 244
PM10, µg/m3 139 49 127 109 167 56 320
CO2, ppm 1669 601 1469 1195 2104 829 3111
Ventilation, l/s per person 0.87 1.38 0.33 0.21 0.78 0.11 7.21
Temperature, ºC 20.5 2.06 20.8 19.2 21.7 14.3 24.6
Relative humidity, % 55 10 54 50 65 34 74
Microbiological
Bacteria, CFU/m3 3626 2269 3224 1784 5430 168 8372
Fungi, CFU/m3 323 235 240 169 400 61 1322
WHO AQ guidelines (24 hr)PM2.5 = 25 µg/m3
PM10 = 50 µg/m3
ASHRAE
CO2 =1000 ppmPortuguese legislation
Bacteria = 500 CFU/m3PM, CO2 and bacteria exceededthe existing guidelines values.
Note: data corresponds to the teaching hours, except the ventilation rate estimation
Physical, comfort parameters and biological agents in classrooms ( n=73)
No significant association found between chemical,physical and microbiological agents and eczema, eyeirritation and nose symptoms (present past 3 months).
4. Results and Discussion
Associations between indoor exposure variables and children’s health outcomes
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Toluenem/p-xylene; o-
xylened-limoneneα-pinene
TVOCFormaldehydeAcetaldehyde
CO
PM2.5,PM10CO2
TemperatureRel. humidity
BacteriaFungi
•Wheeze (<12 months), Wheeze (<30 days)•Ever nasal allergy•Cough episodesǂ
•Phlegm episodesǂ
•Skin symptoms•Eczema•Eye irritation•Nose symptoms•Irritating cough
No significant association found between otherchemical parameters and wheeze, nasal allergy, coughand phlegm episodes.
ISAAC question*
Recent symptoms**
*Ever, past year and past monthǂ apart common colds
** past 3 months
Indoor air exposure vs. health outcomes
4. Results and Discussion
Association between indoor TVOC levels and wheeze (n=978)
Children exposed to TVOC at levels approximately ≥100 µg/m3
had a twofold increased risk of having asthma-related symptoms.
Wheeze (<12 months) Wheeze (<30 days)
TVOC, µg/m3 OR (95% CI) aOR (95% CI) OR (95% CI) aOR (95% CI)
<101.87 1 1 1 1
101.87-189.93 1.58 (0.96-2.61) 1.67 (0.93-3.00) 1.95 (0.89-4.26) 2.56 (1.05-6.25)
≥189.94 1.42 (0.86-2.32) 1.64 (0.94-2.85) 2.22 (1.05-4.67) 2.67 (1.15-6.18)
adjusted OR for age, sex, mother’s education, body mass index, relative humidity and temperature.
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Indoor air exposure vs. health outcomes
Wheeze (<12 months) Wheeze (<30 days)
OR (95% CI) aOR (95% CI) OR (95% CI) aOR (95% CI)PM2.5, µg/m3
<72.53 1 1 1 172.53-97.92 1.35 (0.81-2.26) 1.72 (0.96-3.08) 1.44 (0.64-3.22) 1.44 (0.62-3.39)
≥97.93 1.48 (0.88-2.48) 1.90 (1.04-3.45) 2.20 (1.02-4.74) 2.28 (1.00-5.18)
PM10, µg/m3
<116.77 1 1 1 1116.77-137.88 1.07 (0.64-1.80) 1.23 (0.66-2.27) 1.85 (0.78-4.39) 1.58 (0.61-4.09)
≥137.89 1.48 (0.90-2.45) 1.93 (1.07-3.49) 2.96 (1.30-6.73) 3.00 (1.23-7.33)
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4. Results and Discussion
Associations between indoor PM2.5 and PM10 levels and wheeze (n=978)
adjusted OR for age, sex, mother’s education, body mass index, relative humidity and temperature.
Higher PM2.5 and PM10 levels increase the odds of asthma-likesymptoms; the association was stronger for PM10.
Indoor air exposure vs. health outcomes
Increasing odds of irritating cough with increasing levels of PM2.5and PM10 were found.
Nose symptoms Irritating cough
OR (95% CI) aOR (95% CI) OR (95% CI) aOR (95% CI)
PM2.5, µg/m3
<72.53 1 1 1 172.53-97.92 1.14 (0.63-2.03) 1.05 (0.55-2.00) 1.50 (1.04-2.14) 1.54 (1.04-2.28)
≥97.93 1.78 (1.03-3.10) 1.52 (0.82-2.82) 1.49 (1.03-2.16) 1.54 (1.03-2.31)
PM10, µg/m3
<116.77 1 1 1 1116.77-137.88 1.56 (0.85-2.83) 1.01 (0.51-2.01) 1.44 (1.00-2.08) 1.52 (1.01-2.30)
≥137.89 2.15 (1.20-3.84) 1.66 (0.88-3.15) 1.52 (1.05-2.19) 1.64 (1.08-2.47)
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4. Results and Discussion
Associations between indoor PM2.5 and PM10 levels and irritating cough (n=846)
adjusted OR for age, sex, mother’s education, body mass index, relative humidity and temperature.
Indoor air exposure vs. health outcomes
• All chemical´s concentrations in the classrooms were ingeneral below the existing WHO guideline values.
• PM2.5 and PM10, levels generally exceeded the establishedguidelines values.
• CO2 values exceed recommended limits.
• Children exposed to TVOC at levels over 100 µg/m3 had atwofold increased risk of having asthma-related symptoms.
• The present study supports the pro-inflammatory role of PM2.5and PM10, especially among the most susceptible children.
5. Conclusions
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Obrigada!Thank you!
July 7-12 2014, Hong Kong
Wednesday, July 09, 2014(A6) Health and Indoor air epidemiology
Joana [email protected]
This study is supported by the Portuguese Foundation for Science and Technology(FCT) through the ARIA project (PTDC/DTP-SAP/1522/2012).