Indoor exposure to environmental tobacco smoke and dampness: Respiratory symptoms in Sardinian children—DRIAS study☆
Introduction
Respiratory health of children is adversely affected by indoor exposures at home, mainly deriving from parental smoking and mould or dampness exposure.
In 2002, a comprehensive quantitative review concluded that the evidence that the environmental tobacco smoke (ETS) exposure in childhood causes chronic respiratory symptoms (cough, phlegm, and wheezing) is strong and consistent, ETS has a causal role in asthma, especially in its induction (Jaakkola and Jaakkola, 2002). The role of ETS in increasing wheeze and asthma risk is consistent with investigations in Italy (SIDRIA 1 and 2-Studi Italiani sui Disturbi Respiratori nell’Infanzia e l’Ambiente) (Agabiti et al., 1999; De Sario et al., 2005) and in other countries (Spengler et al., 2004; Raherison et al., 2007). For smoking in pregnancy, ETS exposure may predict the development of asthma later in life (Jaakkola and Jaakkola, 2002). Successive studies showed that maternal smoking during pregnancy increases the risk of wheeze and asthma (Spengler et al., 2004; Zlotkowska and Zejda, 2005; Zacharasiewicz et al., 2000), observation in agreement with Italian investigations (Agabiti et al., 1999; De Sario et al., 2005).
The studies on the relationship of ETS to childhood eczema and rhinitis are not consistent (Raherison et al., 2007; Zacharasiewicz et al., 2000; Kramer et al., 2004).
Many investigations observed an association between home mould or dampness and respiratory symptoms. For indoor dampness, there is sufficient evidence for exacerbation of asthma symptoms, but whether exposure to dampness also causes development of asthma is still unclear (Douwes and Pearce, 2003; IOM report-Institute of Medicine (US), 2004). Also in Italy, SIDRIA 2 observed an increased prevalence for asthma and wheeze (Simoni et al., 2005).
Rhino-conjunctivitis and eczema as well as cough/phlegm are positively related to home mould/dampness in a number of epidemiological investigations (Zacharasiewicz et al., 2000; Simoni et al., 2005; McNally et al., 2001).
The aim of the present study, named Disturbi Respiratori nell’Infanzia e Ambiente in Sardegna (DRIAS)—Respiratory Symptoms in children and the Environment in Sardegna, Italy) is to relate the prevalence of respiratory and allergic symptoms to indoor exposures to ETS and mould or dampness in children living in Sardegna, a southern Italian island. DRIAS results contribute to the knowledge on adverse effects of indoor exposures on respiratory health of children providing evidence from southern Mediterranean populations not previously investigated for these age groups. Sardinian populations have genetic homogeneity, they also share much of the same environment which reduces non-genetic sources of variation, these characteristics make them appropriate for the study of asthma, a multifactorial disease influenced by genetic and environmental factors (Balaci et al., 2007).
Section snippets
Study subjects
All children attending 29 primary schools located in nine villages in the South–West area of Sardegna-Italy, were included in DRIAS study and investigated during the school year 2004–2005. In Italy, children start primary school at 5 years of age and primary school is compulsory for 5 years. Study subjects amounted to 4122 children.
Study design
A cross-sectional investigation of respiratory symptoms/diseases was carried out in the period January–April 2005. A self-administered questionnaire, a modified
Results
Response rate is 84.4% (3477 out of 4122 distributed questionnaires were filled in and returned). Questionnaires without answers to one or more of the main core questions of ISAAC questionnaires (lifetime presence of wheezing, rhinitis, and eczema symptoms) were excluded from the analysis. Valid questionnaires with adequate information for the analysis were available for 3455 children (83.8%). Information about siblings was not registered. On the basis of data on address and parents’ birth, it
Discussion
In the present cross-sectional study, an association was observed between parental smoking and current wheeze and current asthma, the prevalence is doubled if both parents smoke, for persistent cough or phlegm the major role is for “only mother smoker”. An increased prevalence for current wheeze and current asthma is observed for smoking in pregnancy. Exposure to ETS and family atopy have a joint effect with an almost tripled prevalence for current wheeze and more than four times for current
Acknowledgments
The DRIAS Collaborative Group included: A. Antonelli, A. Bracciotti, PL. Cocco, M. Budroni, S. Lecca, R. Masala, L. Minerba, P. Pallazzoni, A. Serci, G. Viegi.
The authors are grateful to all schoolchildren and their parents for participating in the study, to school caretakers, teachers and school directors for their help in making the investigation possible. The authors thank BIOMEDIN company for making available portable spirometers. The authors thank Paolo Murgia and Giacomo Balestra for
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Funding: DRIAS study was funded by the Italian Ministry of Health—EU PON ATAS 2000–2006, and conducted by ESA consortium 2003–2005 (for details A. Biggeri, Department of Statistics University of Florence). DRIAS study protocol was approved by the Ethical Committee of Local Health Unit n.8, Sardegna Region on January 8, 2005.