Respiratory Disease Rates in Israel Prof' Haim Bibi

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?? ?????? ??????? ?????? ???? ??????Respiratory
Disease Rates in Israel Prof. Haim Bibi

• Lung disease that may be influenced by exposure
  to air-pollution
• Asthma Pediatric
• AsthmaAdult
• COPD
• Occupational Lung Disease

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Pediatric Asthma

• Children are the most sensitive group
• Immaturity of respiratory and immune system
• Asthma is the most common chronic respiratory
  symptom among children
• The most available data on respiratory morbidity
  in Israel is childhood asthma

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Ways of Diagnosis

• Questionnaire
• NHLB NIH
• ISACC
• Spirometry Challenge tests Cold air,
  Methacholine, Adenosine
• Doctor diagnosis ( Questionnaire)

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?????? Asthma rates in children, questionnaire
NHLB-NIH
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??????? ISACC Asthma rates in children, ISACC
questionnaire
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• The medical records of 531,116 Israeli military
  conscripts were reviewed. Asthma was diagnosed
  in 26,833 male subjects (8.6) and 15,079 female
  subjects (6.9).
• Asthma Prevalence, Family Size, and Birth
  OrderShmuel Goldberg, MD Chest 2007

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International Asthma prevalence based on ISACC
ECHRS
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International Asthma prevalence based on ISACC
ECHRS
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Prevalence of asthma and atopy in two areas of
West and East Germany

• The prevalence of asthma and bronchial hyper
  responsiveness (BHR) in 9- to 11-year old
  children in West Germany (n 5,030) and East
  Germany (n 2,623).
• A self-administered questionnaire was
  distributed to the parents. Children underwent
  cold air challenge.
• The prevalence of current asthma was
  significantly higher in West Germany when
  compared with that in East Germany (5.9 versus
  3.9 OR 1.5, p lt 0.0001, respectively).
• The prevalence of BHR as assessed by cold air
  challenge was higher in West Germany compared
  with that in East Germany (8.3 versus 5.5, OR
  1.6, p lt 0.001)
• Von Mutius E Am J Respir Crit Care Med 1994

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Pulmonary Function Tests

• Relevance ??
• Pulmonary function
• Increase within age according to height velocity

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Exposure to air pollution is proved to induction
of impaired growth of pulmonary function among
children

• Higher pollutant levels were independently
  associated with reduced lung function in a
  3-pollutant model. Higher concentrations of NO(2)
  and particles smaller than 2.5 µ were associated
  with asthma-related missed school days, and
  higher NO(2) concentrations were associated with
  asthma symptoms Acute respiratory health effects
  of air pollution on children with asthma in US
  inner cities O'Connor GT J Allergy Clin Immunol
  April 2008
• Traffic-related air pollution exposure during the
  first year of life was also associated with lower
  lung function at 4 years of age. Results were
  similar using traffic-NOx and traffic-PM10 as
  indicators Traffic-Related Air Pollution and
  Childhood Respiratory Symptoms, Function and
  Allergies Nordling E Epidemiology May 2008
• Decreasing exposure to airborne particulates
  appears to attenuate the decline in lung function
  related to exposure to PM10. The effects are
  greater in tests reflecting small-airway function
• Reduced exposure to PM10 and attenuated
  age-related decline in lung function N Engl J Med
  Dec 2007 Downs SH
• long-term exposure to O(3), PM(10), and NO(2) is
  associated with a deficit in FVC and FEV(1)
  growth among schoolchildren living in Mexico City
  Lung function growth in children with long-term
  exposure to air pollutants in Mexico City
  Rojas-Martinez R Am J Respir Crit Care Med
  Aug 2007

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Exposure to air pollution is proved to induction
of impaired growth of pulmonary function among
children

• A sensitivity test revealed a FEV(1) decline from
  -4.3 for the average pollution level to -10.2
  for the high air pollution level. As we conclude,
  air pollution from a coal-fired power station,
  although not exceeding local pollution standards,
  had a negative effect on children's lung function
  development Estimating the effect of air
  pollution from a coal-fired power station on the
  development of children's pulmonary function
  Dubnov J Environ Res 2007 Jan
• Prospective study, recruited 1759 children
  (average age, 10 years) from schools in 12
  southern California communities and measured lung
  function annually for eight years Current levels
  of air pollution have chronic, adverse effects on
  lung development in children from the age of 10
  to 18 years, leading to clinically significant
  deficits in attained FEV(1) as children reach
  adulthood The effect of air pollution on lung
  development from 10 to 18 years of age Gauderman
  WJ N Engl J Med. Sep 2004

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