Chronic respiratory symptoms in children following in utero and early life exposure to arsenic in drinking water in Bangladesh.
BACKGROUND
Arsenic exposure via drinking water increases the risk of chronic respiratory disease in adults. However, information on pulmonary health effects in children after early life exposure is limited.


METHODS
This population-based cohort study set in rural Matlab, Bangladesh, assessed lung function and respiratory symptoms of 650 children aged 7-17 years. Children with in utero and early life arsenic exposure were compared with children exposed to less than 10 µg/l in utero and throughout childhood. Because most children drank the same water as their mother had drunk during pregnancy, we could not assess only in utero or only childhood exposure.


RESULTS
Children exposed in utero to more than 500 µg/l of arsenic were more than eight times more likely to report wheezing when not having a cold [odds ratio (OR) = 8.41, 95% confidence interval (CI): 1.66-42.6, P < 0.01] and more than three times more likely to report shortness of breath when walking on level ground (OR = 3.86, 95% CI: 1.09-13.7, P = 0.02) and when walking fast or climbing (OR = 3.19, 95% CI: 1.22-8.32, P < 0.01]. However, there was little evidence of reduced lung function in either exposure category.


CONCLUSIONS
Children with high in utero and early life arsenic exposure had marked increases in several chronic respiratory symptoms, which could be due to in utero exposure or to early life exposure, or to both. Our findings suggest that arsenic in water has early pulmonary effects and that respiratory symptoms are a better marker of early life arsenic toxicity than changes in lung function measured by spirometry.
Arsenic Health Effects Research Program, School of Public Health, University of California, Berkeley, CA, USA, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh, Department of Medicine, University of California, San Francisco, CA, USA, Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, CA, USA, Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA and Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, CA, USA.
Allan H
AH
Smith
Mohammad
M
Yunus
Al Fazal
AF
Khan
Ayse
A
Ercumen
Yan
Y
Yuan
Meera Hira
MH
Smith
Jane
J
Liaw
John
J
Balmes
Ondine
O
von Ehrenstein
Rubhana
R
Raqib
David
D
Kalman
Dewan S
DS
Alam
Peter K
PK
Streatfield
Craig
C
Steinmaus
D000293:Adolescent; D001151:Arsenic / Q000633:toxicity*; D001459:Bangladesh / Q000453:epidemiology; D002648:Child; D060766:Drinking Water / Q000009:adverse effects*; D004781:Environmental Exposure / Q000009:adverse effects; D004812:Epidemiologic Methods; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008297:Male; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000139:chemically induced* / Q000453:epidemiology; D012120:Respiration Disorders / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology; D014797:Vital Capacity / Q000502:physiology; D014874:Water Pollutants, Chemical / Q000633:toxicity*
D060766:Drinking Water; D014874:Water Pollutants, Chemical; D001151:Arsenic
Arsenic; children; in utero; lung function; pulmonary; respiratory