Gas cooking, respiratory health and white blood cell counts in children

doi:10.1078/S1438-4639(04)70005-X

International Journal of Hygiene and Environmental Health

Volume 203, Issue 1, 2000, Pages 29-37

https://doi.org/10.1078/S1438-4639(04)70005-X Get rights and content

Summary

The use of gas stoves has been associated with respiratory symptoms of chronic airway inflammation and higher rates of respiratory infections. We used data from a 1992/93 survey of 2,198 East German school children (aged 5 to 14) to assess whether gas cooking increases respiratory symptoms and is associated with a chronic inflammatory process reflected by an increase in white blood cell (WBC) count in children who do not exhibit signs of an acute respiratory infection. We found increases for the respiratory symptoms ‘cough without cold’ [odds ratio (OR)1.68; 95% confidence interval (CI), 1.18-2.39], ‘cough in the morning’ (OR1.58; CI, 1.23-2.04) and ‘cough during the day or at night’ (OR1.42; CI, 1.13-1.78) in children living in homes with gas ranges, but lifetime prevalence of asthma, bronchitis, wheeze, and the prevalence of acute infections were not affected. Furthermore, we examined WBC levels in a subgroup of 1,134 children for whom blood samples were available and who did not suffer from an acute infection. We observed small increases in the risk of having WBC counts above the 75^th or 90^th percentile (8300 or 9800 cell counts per µl) when children were exposed to gas cooking after adjustment for age, gender, and passive smoking (OR1.30; CI, 0.98-1.73, and OR1.38; CI, 0.91-2.10). The strongest effect estimates for chronic inflammation were found for those children likely to have been exposed at higher levels, that is when stoves had no fans, in smaller homes, and for children spending more time indoors.

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Cited by (23)

Gas cooking indoors and respiratory symptoms in the ECRHS cohort
2024, International Journal of Hygiene and Environmental Health
Gas cooking is an important source of indoor air pollutants, and there is some limited evidence that it might adversely be associated with respiratory health. Using repeated cross-sectional data from the multi-centre international European Community Respiratory Health Survey, we assessed whether adults using gas cookers have increased risk of respiratory symptoms compared to those using electric cookers and tested whether there was effect modification by a priori selected factors.
Data on respiratory symptoms and gas cooking were collected from participants at 26–55 and 38–67 years (median time between examinations 11.4 years) from interviewer-led questionnaires. Repeated associations between gas cooking (versus electric) and respiratory symptoms were estimated using multivariable mixed-effects logistic regression models adjusted for age, sex, study arm, smoking status, education level, and included random intercepts for participants within study centres. Analyses were repeated using a 3-level variable for type of cooker and gas source. Effect modification by ventilation habits, cooking duration, sex, age atopy, asthma, and study arm were examined.
The sample included 4337 adults (43.7% males) from 19 centres in 9 countries. Gas cooking increased the risk of “shortness of breath whilst at rest” (OR = 1.38; 95%CI: 1.06–1.79) and “wheeze with breathlessness” (1.32; 1.00–1.74). For several other symptoms, effect estimates were larger in those who used both gas hobs and ovens, had a bottled gas source and cooked for over 60 min per day. Stratifying results by sex and age found stronger associations in females and younger adults.
This multi-centre international study, using repeat data, suggested using gas cookers in the home was more strongly associated than electric cookers with certain respiratory symptoms in adults. As gas cooking is common, these results may play an important role in population respiratory health.
Gas cooking and respiratory outcomes in children: A systematic review
2023, Global Epidemiology
The most recent meta-analysis of gas cooking and respiratory outcomes in children was conducted by Lin et al. [93] in 2013. Since then, a number of epidemiology studies have been published on this topic. We conducted the first systematic review of this epidemiology literature that includes an in-depth evaluation of study heterogeneity and study quality, neither of which was systematically evaluated in earlier reviews. We reviewed a total of 66 relevant studies, including those in the Lin et al. [93] meta-analysis. Most of the studies are cross-sectional by design, precluding causal inference. Only a few are cohort studies that could establish temporality and they have largely reported null results. There is large variability across studies in terms of study region, age of children, gas cooking exposure definition, and asthma or wheeze outcome definition, precluding clear interpretations of meta-analysis estimates such as those reported in Lin et al. [93]. Further, our systematic study quality evaluation reveals that a large proportion of the studies to date are subject to multiple sources of bias and inaccuracy, primarily due to self-reported gas cooking exposure or respiratory outcomes, insufficient adjustment for key confounders (e.g., environmental tobacco smoke, family history of asthma or allergies, socioeconomic status or home environment), and unestablished temporality. We conclude that the epidemiology literature is limited by high heterogeneity and low study quality and, therefore, it does not provide sufficient evidence regarding causal relationships between gas cooking or indoor NO₂ and asthma or wheeze. We caution against over-interpreting the quantitative evidence synthesis estimates from meta-analyses of these studies.
Adverse health effects of lead exposure on physical growth, erythrocyte parameters and school performances for school-aged children in eastern China
2020, Environment International
Citation Excerpt :
However, there were no significant associations between BPbs and BMI, which may be due to the insufficient sample size or other factors affecting BMI. The hematological system is generally regarded as a sensitive target tissue of lead exposure (Hölscher et al., 2000). Previous analyses recognized that lead interferes with several steps of heme biosynthesis, such as disturbing the activity of three major enzymes, and it plays an important role in regulation of RBC formation and function (Mushak et al., 1989).
We conducted a cross-sectional study with 395 completely matched student samples enrolled from a public primary school in Nanjing of eastern China, including questionnaires, blood samples, growth indexes and school performances, all of which were used for the analysis of variance (ANOVA) and general linear model (GLM). The results showed that factors, such as gender, age, parents’ education, residential passive smoking and picky eaters, had significant impacts on the blood lead levels (BPbs). As for the linear and non-linear dose-response relationship between BPbs and erythrocyte parameters, we found a positive association between BPbs and red blood cell count (RBC count) and mean corpuscular hemoglobin concentration (MCHC) but a negative association between BPbs and hemoglobin (HGB), hematocrit (HCT), mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH). When BPbs increased by 10 μg/L, the RBC count increased by 0.18 × 10¹²/L, while HGB and HCT decreased by 1.19 g/L and 0.41% for boys, respectively. As for girls, corresponding increases in RBC count was 0.05 × 10¹²/L, while HGB and HCT decreased by 0.82 g/L and 0.23%. Meanwhile, for both boys and girls, MCHC increased by 2.55 g/L, while MCV and MCH levels decreased by 0.41 fL and 0.12 pg each. Furthermore, a remarkable adverse effect (p < 0.05) was observed on children’s school performances as a result of increased BPbs. As BPbs increased by 10 μg/L, children’s scores for Chinese, Math and English decreased by 0.42 points, 0.39 points and 0.87 points, respectively. In summary, our study indicated that lead exposure can have adverse health effects on children's erythrocyte parameters, BMI, and school performances.
Cough in the Pediatric Population
2010, Otolaryngologic Clinics of North America
Citation Excerpt :
When reviewing any child with cough irrespective of the cause, exacerbation factors should be explored, although no RCTs have examined the effect of cessation of environmental pollutants on cough. There is little doubt that children with environmental tobacco smoke (ETS) exposure have increased risk of having chronic67,68 and recurrent cough.69 Cough resolution was achieved in children exposed to ETS, however, in several studies,11,40 which suggests that ETS alone is not the sole cause.
Bronchiectasis
2006, Kendig's Disorders of the Respiratory Tract in Children
Guidelines for evaluating chronic cough in pediatrics: ACCP evidence-based clinical practice guidelines
2006, Chest
Citation Excerpt :
Exposure to indoor biomass combustion increases coughing illness associated with respiratory infections with an exposure-response effect.151 Exposure to other ambient pollutants (eg, particulate matter,152,153 nitrogen dioxide, and gas cooking154) is also associated with increased cough in children in both cross-sectional studies152,153 and longitudinal studies,155 especially in the presence of other respiratory illness such as asthma.152 Some studies,156,157 however, have not shown this effect, and this may be related partially to problems in questionnaire-based epidemiologic studies on isolated and nocturnal cough.9,27
To review relevant literature and present evidence-based guidelines to assist general and specialist medical practitioners in the evaluation and management of children who present with chronic cough.
The Cochrane, MEDLINE, and EMBASE databases, review articles, and reference lists of relevant articles were searched and reviewed by a single author. The date of the last comprehensive search was December 5, 2003, and that of the Cochrane database was November 7, 2004. The authors' own databases and expertise identified additional articles.
Pediatric chronic cough (ie, cough in children aged < 15 years) is defined as a daily cough lasting for > 4 weeks. This time frame was chosen based on the natural history of URTIs in children and differs from the definition of chronic cough in adults. In this guideline, only chronic cough will be discussed. Chronic cough is subdivided into specific cough (ie, cough associated with other symptoms and signs suggestive of an associated or underlying problem) and nonspecific cough (ie, dry cough in the absence of an identifiable respiratory disease of known etiology). The majority of this section focuses on nonspecific cough, as specific cough encompasses the entire spectrum of pediatric pulmonology. A review of the literature revealed few randomized controlled trials for treatment of nonspecific cough. Management guidelines are summarized in two pathways. Recommendations are derived from a systematic review of the literature and were integrated with expert opinion. They are a general guideline only, do not substitute for sound clinical judgment, and are not intended to be used as a protocol for the management of all children with a coughing illness. Children (aged < 15 years) with cough should be managed according to child-specific guidelines, which differ from those for adults as the etiologic factors and treatments for children are sometimes different from those for adults. Cough in children should be treated based on etiology, and there is no evidence for using medications for the symptomatic relief of cough. If medications are used, it is imperative that the children are followed up and therapy with the medications stopped if there is no effect on the cough within an expected time frame. An evaluation of the time to response is important. Irrespective of diagnosis, environmental influences and parental expectations should be discussed and managed accordingly. Cough often impacts the quality of life of both children and parents, and the exploration of parental expectations and fears is often valuable in the management of cough in children.

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Gas cooking, respiratory health and white blood cell counts in children

Summary

Atmos. Environ.

Lancet

Ann. Epidemiol.

Lancet

Passive smoking by humans sensitizes circulating neutrophils

Am. Rev. Respir. Dis.

International study of asthma and allergies in childhood (ISAAC): rationale and methods

Eur. Respir. J.

The inflammatory effects of 2 ppm NO2 on the airways of healthy subjects

Am. J. Respir. Crit. Care Med.

Indoor NOi concentrations in Erfurt homes -development and testing of a strategy for exposure assessment of an epidemiological study (German)

Allergologie

Respiratory health effects of the indoor environment in a population of Dutch children

Am. Rev. Respir. Dis.

The effects of housing on the health of preterm infants

Pae-diatr. Perinat. Epidemiol.

Nitrogen dioxide, the oxides of nitrogen, and infants health symptoms. ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood

Arch. Environ. Health

Synthesis of environmental evidence: nitrogen dioxide epidemiology studies

J. Air Waste Manage. Assoc.

Respiratory diseases and allergies in two polluted areas in east Germany

Environ. Health Perspect

Applied Logistic Regression

The association of respiratory symptoms and lung function with the use of gas for cooking. European Community Respiratory Health Survey

Eur. Respir. J.