Division of Pulmonary and Critical Care Medicine, Boston University School of Medicine, Boston University Medical Center 72 East Concord Street, R304, Boston, MA 02118, USA.
Department of Global Health, Boston University School of Public Health, Boston, MA 02118, USA.
Int J Environ Res Public Health. 2020 Dec 29;18(1):183. doi: 10.3390/ijerph18010183.
BACKGROUND: In India, biomass fuel is burned in many homes under inefficient conditions, leading to a complex milieu of particulate matter and environmental toxins known as household air pollution (HAP). Pregnant women are particularly vulnerable as they and their fetus may suffer from adverse consequences of HAP. Fractional exhaled nitric oxide (FeNO) is a noninvasive, underutilized tool that can serve as a surrogate for airway inflammation. We evaluated the prevalence of respiratory illness, using pulmonary questionnaires and FeNO measurements, among pregnant women in rural India who utilize biomass fuel as a source of energy within their home. METHODS: We prospectively studied 60 pregnant women in their 1st and 2nd trimester residing in villages near Nagpur, Central India. We measured FeNO levels in parts per billion (ppb), St. George's Respiratory Questionnaire (SGRQ-C) scores, and the Modified Medical Research Council (mMRC) Dyspnea Scale. We evaluated the difference in the outcome distributions between women using biomass fuels and those using liquefied petroleum gas (LPG) using two-tailed t-tests. RESULTS: Sixty-five subjects (32 in Biomass households; 28 in LPG households; 5 unable to complete) were enrolled in the study. Age, education level, and second-hand smoke exposure were comparable between both groups. FeNO levels were higher in the Biomass vs. LPG group (25.4 ppb vs. 8.6 ppb; -value = 0.001). There was a difference in mean composite SGRQ-C score (27.1 Biomass vs. 10.8 LPG; -value < 0.001) including three subtotal scores for Symptoms (47.0 Biomass vs. 20.2 LPG; -value< 0.001), Activity (36.4 Biomass vs. 16.5 LPG; -value < 0.001) and Impact (15.9 Biomass vs. 5.2 LPG; -value < 0.001). The mMRC Dyspnea Scale was higher in the Biomass vs. LPG group as well (2.9 vs. 0.5; < 0.001). CONCLUSION: Increased FeNO levels and higher dyspnea scores in biomass-fuel-exposed subjects confirm the adverse respiratory effects of this exposure during pregnancy. More so, FeNO may be a useful, noninvasive biomarker of inflammation that can help better understand the physiologic effects of biomass smoke on pregnant women. In the future, larger studies are needed to characterize the utility of FeNO in a population exposed to HAP.
背景：在印度，许多家庭在低效条件下燃烧生物质燃料，导致形成了一种复杂的颗粒物和环境毒素混合物，称为室内空气污染（HAP）。孕妇尤其容易受到影响，因为她们和胎儿可能会因 HAP 的不良后果而遭受影响。呼出气一氧化氮分数（FeNO）是一种非侵入性、利用不足的工具，可以作为气道炎症的替代指标。我们评估了印度农村地区使用生物质燃料作为家庭能源的孕妇中，使用肺部问卷和 FeNO 测量的呼吸道疾病患病率。
方法：我们前瞻性地研究了居住在印度中央那格浦尔附近村庄的 60 名处于第一和第二孕期的孕妇。我们以十亿分之几（ppb）为单位测量了 FeNO 水平、圣乔治呼吸问卷（SGRQ-C）评分和改良的医学研究委员会（mMRC）呼吸困难量表。我们使用双尾 t 检验评估了使用生物质燃料的女性和使用液化石油气（LPG）的女性之间的结果分布差异。
结果：本研究共纳入 65 名受试者（生物质燃料组 32 名；LPG 组 28 名；5 名无法完成）。两组的年龄、教育水平和二手烟暴露相当。生物质燃料组的 FeNO 水平高于 LPG 组（25.4 ppb 比 8.6 ppb；-值=0.001）。生物质燃料组的平均综合 SGRQ-C 评分也更高（27.1 比 10.8；-值<0.001），包括症状（47.0 比 20.2；-值<0.001）、活动（36.4 比 16.5；-值<0.001）和影响（15.9 比 5.2；-值<0.001）三个亚总评分。此外，生物质燃料组的 mMRC 呼吸困难量表评分也更高（2.9 比 0.5；<0.001）。
结论：暴露于生物质燃料的受试者的 FeNO 水平升高和呼吸困难评分升高证实了这种暴露在怀孕期间对呼吸的不良影响。此外，FeNO 可能是一种有用的、非侵入性的炎症生物标志物，可以帮助更好地了解生物质烟雾对孕妇的生理影响。未来，需要进行更大规模的研究来描述 FeNO 在暴露于 HAP 的人群中的效用。
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