title: Indoor air quality, ventilation and respiratory health in elderly residents living in nursing homes in Europe.
abstract: Few data exist on respiratory effects of indoor air quality and comfort parameters in the elderly. In the context of the GERIE study, we investigated for the first time the relationships of these factors to respiratory morbidity among elderly people permanently living in nursing homes in seven European countries. 600 elderly people from 50 nursing homes underwent a medical examination and completed a standardised questionnaire. Air quality and comfort parameters were objectively assessed in situ in the nursing home. Mean concentrations of air pollutants did not exceed the existing standards. Forced expiratory volume in 1 s/forced vital capacity ratio was highly significantly related to elevated levels of particles with a 50% cut-off aerodynamic diameter of <0.1 µm (PM0.1) (adjusted OR 8.16, 95% CI 2.24-29.3) and nitrogen dioxide (aOR 3.74, 95% CI 1.06-13.1). Excess risks for usual breathlessness and cough were found with elevated PM10 (aOR 1.53 (95% CI 1.15-2.07) and aOR 1.73 (95% CI 1.17-10.3), respectively) and nitrogen dioxide (aOR 1.58 (95% CI 1.15-2.20) and aOR 1.56 (95% CI 1.03-2.41), respectively). Excess risks for wheeze in the past year were found with PM0.1 (aOR 2.82, 95% CI 1.15-7.02) and for chronic obstructive pulmonary disease and exhaled carbon monoxide with formaldehyde (aOR 3.49 (95% CI 1.17-10.3) and aOR 1.25 (95% CI 1.02-1.55), respectively). Breathlessness and cough were associated with higher carbon dioxide. Relative humidity was inversely related to wheeze in the past year and usual cough. Elderly subjects aged ≥80 years were at higher risk. Pollutant effects were more pronounced in the case of poor ventilation. Even at low levels, indoor air quality affected respiratory health in elderly people permanently living in nursing homes, with frailty increasing with age. The effects were modulated by ventilation.
authors.affiliation: INSERM, U1136 IPLESP EPAR, Paris, France Université Pierre et Marie Curie - Sorbonne Universités, UMR S 1136 IPLESP EPAR, Paris, France.
authors.forename: Malek
authors.initials: M
authors.lastname: Bentayeb
authors.affiliation: Dept of Medical Science, Occupational and Environmental Medicine, Uppsala University, University Hospital, Uppsala, Sweden.
authors.forename: Dan
authors.initials: D
authors.lastname: Norback
authors.affiliation: 2nd Dept of Respiratory Medicine, National Research Institute of Tuberculosis and Lung Diseases, Warsaw, Poland.
authors.forename: Micha
authors.initials: M
authors.lastname: Bednarek
authors.affiliation: Dept of Public Health, Catholic University of Louvain, Brussels, Belgium.
authors.forename: Alfred
authors.initials: A
authors.lastname: Bernard
authors.affiliation: Dept of Medical Science, Occupational and Environmental Medicine, Uppsala University, University Hospital, Uppsala, Sweden.
authors.forename: Guihong
authors.initials: G
authors.lastname: Cai
authors.affiliation: Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy.
authors.forename: Sonia
authors.initials: S
authors.lastname: Cerrai
authors.affiliation: Pulmonary and Critical Care Dept, Asthma Centre, Athens University, Athens, Greece.
authors.forename: Konstantinos Kostas
authors.initials: KK
authors.lastname: Eleftheriou
authors.affiliation: Pulmonary and Critical Care Dept, Asthma Centre, Athens University, Athens, Greece.
authors.forename: Christina
authors.initials: C
authors.lastname: Gratziou
authors.affiliation: Section of Environment, Occupation and Health, Dept of Public Health, University of Aarhus, Aarhus, Denmark.
authors.forename: Gitte Juel
authors.initials: GJ
authors.lastname: Holst
authors.affiliation: Service de Pneumologie et Allergologie CHU Reims, Reims, France.
authors.forename: François
authors.initials: F
authors.lastname: Lavaud
authors.affiliation: 2nd Dept of Respiratory Medicine, National Research Institute of Tuberculosis and Lung Diseases, Warsaw, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Nasilowski
authors.affiliation: Institute of Respiratory Diseases, Siena, Italy.
authors.forename: Piersante
authors.initials: P
authors.lastname: Sestini
authors.affiliation: Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sarno
authors.affiliation: Section of Environment, Occupation and Health, Dept of Public Health, University of Aarhus, Aarhus, Denmark.
authors.forename: Torben
authors.initials: T
authors.lastname: Sigsgaard
authors.affiliation: Dept of Medical Science, Occupational and Environmental Medicine, Uppsala University, University Hospital, Uppsala, Sweden.
authors.forename: Gunilla
authors.initials: G
authors.lastname: Wieslander
authors.affiliation: 2nd Dept of Respiratory Medicine, National Research Institute of Tuberculosis and Lung Diseases, Warsaw, Poland.
authors.forename: Jan
authors.initials: J
authors.lastname: Zielinski
authors.affiliation: Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy CNR Institute of Biomedicine and Molecular Immunology, Palermo, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Viegi
authors.affiliation: INSERM, U1136 IPLESP EPAR, Paris, France Université Pierre et Marie Curie - Sorbonne Universités, UMR S 1136 IPLESP EPAR, Paris, France.
authors.forename: Isabella
authors.initials: I
authors.lastname: Annesi-Maesano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000393:Air Pollutants / Q000032:analysis*; D016902:Air Pollution, Indoor / Q000032:analysis*; D002248:Carbon Monoxide / Q000032:analysis; D004781:Environmental Exposure; D004784:Environmental Monitoring / Q000379:methods; D005060:Europe; D005260:Female; D005557:Formaldehyde / Q000032:analysis; D016330:Frail Elderly; D006304:Health Status; D016852:Housing for the Elderly; D006801:Humans; D008297:Male; D009585:Nitrogen Dioxide / Q000737:chemistry; D009735:Nursing Homes; D010126:Ozone / Q000032:analysis; D052638:Particulate Matter / Q000032:analysis; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology; D012135:Respiratory Sounds; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014691:Ventilation
chemical_list: D000393:Air Pollutants; D052638:Particulate Matter; D005557:Formaldehyde; D010126:Ozone; D002248:Carbon Monoxide; D009585:Nitrogen Dioxide