Environmental Exposures and Asthma in Women Living in Rural Costa Rica: Results from the ISA Study

摘要

Background: Environmental exposures are contributors to respiratory disease around the world. Pesticide and waste burning exposure may contribute to adverse respiratory outcomes in rural areas. To evaluate the impact of environmental exposures on respiratory health, we studied women in the Infants' Environmental Health Study (ISA), a prospective cohort study of women and children living in the banana-growing region of Costa Rica. Methods: We collected information from women on respiratory outcomes (asthma symptoms and diagnosis) using the European Community Respiratory Health Study questionnaire, height, weight, and environmental exposures, and obtained a urine sample for pesticide analysis. Urine samples were analyzed for the pesticide metabolites 3,5,6-trichloropyridinol (TCP) for chlorpyrifos; dimethylcyclopropane carboxylic acid (DCCA) and 3-phenoxybenzoic acid (3-PBA) for pyrethroids; and 5-hydroxythiabendazole (OHT) for thiabendazole. For each analyte, we dichotomized the exposure measurement at the 75th percentile. We used questionnaire data to calculate an asthma score, which helps to identify untreated, symptomatic asthma. We performed a cross-sectional analysis, using logistic regression adjusted for BMI to identify environmental exposures related to asthma score and asthma diagnosis. Results: Among the 273 women, 21% reported doctor diagnosis of asthma and 39% had an asthma score consistent with asthmatic symptoms. Self-reported doctor-diagnosed asthma was associated with 3-PBA (OR=1.64, 95% CI: [0.85, 3.09]), whereas asthma score was associated with OHT (OR=1.63, [0.93, 2.85]). Asthma score was also associated with residential exposure to air pollution due to burning (OR=2.03, [1.01, 4.32]). This association was stronger with more frequent exposure to waste burning - daily exposure was more likely to lead to a high asthma score than rare exposure (OR=2.31, [1.03, 5.28]). Conclusion: Environmental exposures may contribute to respiratory symptoms in women.