Coelho Sónia D, Maricoto Tiago, Taborda-Barata Luís, Annesi-Maesano Isabella, Isobe Tomohiko, Sousa Ana C A
Centre for Environmental and Marine Studies (CESAM), Department of Biology, University of Aveiro, Portugal.
Beira Ria Health Unit, Aveiro Health Center, Ílhavo, Portugal; GRUBI - Systematic Reviews Group, Faculty of Health Sciences & UBIAir - Clinical & Experimental Lung Centre, CICS-UBI - Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.
Environ Pollut. 2024 Apr 15;347:123733. doi: 10.1016/j.envpol.2024.123733. Epub 2024 Mar 6.
Chronic respiratory diseases are a dealing cause of death and disability worldwide. Their prevalence is steadily increasing and the exposure to environmental contaminants, including Flame Retardants (FRs), is being considered as a possible risk factor. Despite the widespread and continuous exposure to FRs, the role of these contaminants in chronic respiratory diseases is yet not clear. This study aims to systematically review the association between the exposure to FRs and chronic respiratory diseases. Searches were performed using the Cochrane Library, MEDLINE, EMBASE, PUBMED, SCOPUS, ISI Web of Science (Science and Social Science Index), WHO Global Health Library and CINAHL EBSCO. Among the initial 353 articles found, only 9 fulfilled the inclusion criteria and were included. No statistically significant increase in the risk for chronic respiratory diseases with exposure to FRs was found and therefore there is not enough evidence to support that FRs pose a significantly higher risk for the development or worsening of respiratory diseases. However, a non-significant trend for potential hazard was found for asthma and rhinitis/rhinoconjunctivitis, particularly considering urinary organophosphate esters (OPEs) including TNBP, TPHP, TCEP and TCIPP congeners/compounds. Most studies showed a predominance of moderate risk of bias, therefore the global strength of the evidence is low. The limitations of the studies here reviewed, and the potential hazardous effects herein identified highlights the need for good quality large-scale cohort studies in which biomarkers of exposure should be quantified in biological samples.
慢性呼吸道疾病是全球范围内导致死亡和残疾的主要原因。其患病率在稳步上升，接触包括阻燃剂（FRs）在内的环境污染物被认为是一个潜在风险因素。尽管人们广泛且持续接触FRs，但这些污染物在慢性呼吸道疾病中的作用尚不清楚。本研究旨在系统综述FRs暴露与慢性呼吸道疾病之间的关联。检索使用了Cochrane图书馆、MEDLINE、EMBASE、PUBMED、SCOPUS、ISI科学网（科学与社会科学索引）、世界卫生组织全球健康图书馆和CINAHL EBSCO。在最初检索到的353篇文章中，只有9篇符合纳入标准并被纳入。未发现接触FRs会使慢性呼吸道疾病风险出现统计学上的显著增加，因此没有足够证据支持FRs会对呼吸系统疾病的发生或恶化构成显著更高的风险。然而，对于哮喘和鼻炎/鼻结膜炎，发现了潜在危害的非显著趋势，特别是考虑到包括TNBP、TPHP、TCEP和TCIPP同系物/化合物在内的尿有机磷酸酯（OPEs）。大多数研究显示存在中度偏倚风险，因此整体证据力度较低。本文综述的研究局限性以及在此确定的潜在有害影响凸显了开展高质量大规模队列研究的必要性，在这类研究中应在生物样本中对暴露生物标志物进行量化。
