Respiratory Health

(Funded by MRC)

The lung diseases asthma and chronic obstructive pulmonary disease (COPD) are very common. Around the world 300 million people have asthma and 200 million have COPD. Low- to middle-income countries (LMICs) such as Kenya shoulder the burden of asthma and COPD. These diseases interfere with the lives of people, they stop people working and cost them money. The diseases also hold back countries from developing. The Kenyan Government has highlighted asthma and COPD as national priorities. Research from high income countries shows that the process of developing asthma and COPD starts early in life when we are children, or even earlier. Although research has shown that many adults in Africa have reduced lung function, no one has looked to see if this starts early in life.

Our team of researchers and doctors from Kenya and the UK worked closely with two communities in Nairobi, Kenya, to design and carry out a project looking into the early life origins of lung disease. We were interested in what caused lung disease and how people experience lung disease. We wanted to find out how early these diseases started, so that eventually we could prevent lung diseases by targeting the right age groups. Our focus was on children and young adults aged 5 to 18 years because this was the age at which lungs were developing, and ill effects at this time of life could impact the rest of people's lives. We were working in two areas: an informal settlement (Mukuru) and a wealthier area (Bura Bura). These two areas were geographically very close but very different in terms of their socioeconomic make up.

The project involved community members in all stages of the scientific process (including bid-writing, design, data collection, communication and project evaluation). We were particularly interested to look at the effects of indoor and outdoor air pollution, birth weight and early life chest infections.

We conducted a survey of children/young adults aged 5-18 years - 1,000 in Mukuru and 1,000 in Bura Bura. The children and young adults were recruited through local schools. The parents of the young people who wanted to take part were visited by local field workers. The field workers asked questions about lung symptoms, sources of indoor air pollution and any known lung problems. We asked mothers if we could look at the Child Health Card that recorded birth weight, childhood weights and chest infections. We measured the lung function of the young people using a simple blowing test called spirometry. We did this before and after they ran for 6 minutes, a simple way of looking for a form of asthma. To look at the effect of air pollution we measured the air pollution experienced for a day by 100 young people from each community. They were asked if they would wear a bag with some light-weight monitoring equipment for a day. The results of this monitoring was used with the questionnaires to estimate exposure to air pollution for all those taking part.

The information gathered was used to see if more children than expected had reduced lung function and at what age this appeared. We also checked if air pollution, birth weight and early life chest infections affected the lung function of children. This had never been done before in Africa. The study was large enough to make fairly precise estimates of prevalence and looked for associations.

The results of this study were fed back to the two communities in easily understandable ways, including theatre and comics. We also let scientists, doctors and those interested in lung disease know the findings of the study. Although this study would not provide definitive proof, it was the first step for showing that lung diseases in Africa started early in life and could be prevented by targeting the right age group.

ISM Staff: Sean Semple and Ruaraidh Dobson

External: Heather Price, Faculty of Natural Sciences, University of Stirling. Led by Kevin Mortimer, Liverpool School of Tropical Medicine

(Funded by the Medical Research Council)

The aim of the MCLASS II project was to develop and test the effectiveness and cost-effectiveness of a community-based intervention called ‘Muslims for better Health’, with or without Indoor Air Quality (IAQ) feedback, in reducing exposure to second-hand smoke in homes in Dhaka, Bangladesh.

Second-hand Smoke (SHS) was a major public health problem and a priority for policy making in Bangladesh. We had been working with the Islamic Foundation, Bangladesh to develop and test a community-based intervention called ‘Muslims for better Health’ (M4bH) where we would train imams based in mosques to encourage their congregations to make a positive change in their smoking behaviours.

We undertook a large study to examine how effective and cost-effective the M4bH intervention was, with or without IAQ feedback, in reducing exposure to SHS in homes, frequency and severity of respiratory symptoms, and healthcare service use and in improving quality of life.

A pragmatic, three-arm open label, cluster randomised controlled trial (cRCT) with concurrent economic evaluation and process evaluation was conducted in 45 mosques and their catchment communities in Mirpur area of Dhaka, Bangladesh. The three trial arms were as follows:

1. Arm 1: M4bH intervention and IAQ feedback
2. Arm 2: M4bH intervention alone
3. Arm 3: Usual services

The primary outcome would be household SHS concentration measured as fine Particulate Matter less than 2.5 microns diameter (PM2.5) at 3 months post-randomisation. PM2.5 would be measured in homes using the Dylos DC 1700 (Dylos, California, USA) a low-cost particulate counter validated for use in domestic settings. Data from previous work in Scotland indicated that a smoke-free home would have PM25 concentrations that were generally about 5-10 times lower than a home where smoking toke place.

ISM Staff: Sean Semple and Ruaraidh Dobson

External: Led by the University of York

(Funded by the European Commission) (2018-2019)

TackSHS was a new research project funded by the European Union’s Horizon 2020 Research and Innovation Programme. TackSHS aimed to improve understanding of second-hand tobacco smoke and e-cigarette emissions and find ways of tackling the health burden caused by exposure to these aerosols.

This four-year project led by ICO (The Catalan Institute of Oncology) brought together leading European research centres to work in partnership on a comprehensive and integrated approach to generate significant step-change beyond the current state-of-the-art in understanding second-hand tobacco smoke and electronic cigarette aerosols.

The University of Stirling led on Work Package 4: “Measuring for change: air quality feedback to reduce SHS exposure in the home”. This work package examined the efficacy of using personalised air quality measurements in homes of smokers to encourage behaviour-change towards having a smoke-free home environment. Building on recent quantitative and qualitative work by our group which had shown that feedback of second-hand smoke measurement information could help motivate smokers, this WP developed a targeted intervention for use with socio-economically deprived smokers in four locations (Scotland, Catalonia, Greece and Italy) across the EU. Up to 40 smoking households in each country were recruited and offered low-cost, simple to operate particle counting instruments to measure and log SHS levels in their home for a period of 30 days. During this time near real-time, personalised feedback would be provided to, and discussed with, the smoker along with target-setting and exploration of suitable methods of behaviour-change. Feedback would be given via text message to mobile phones, emails and personal voice calls. A final visit would gather data on changes made while a proportion of participants (10-20%) in each country would take part in a further qualitative interview by phone to gather data on their experience of the intervention.

Study outcomes included quantitative measures such as changes in average and maximum fine particulate matter (PM2.5) concentrations and self-declared household smoking rules, while qualitative data was gathered using questionnaire and interview to explore what elements of the intervention were useful/unhelpful, particularly well/poorly understood, and what the barriers were for those who did not make changes. This WP provided a comprehensive database of baseline measurements of SHS concentrations in home settings from across the EU with the potential to generate several million minutes of measurements of household air quality

ISM Staff: Sean Semple, Ruaraidh Dobson and Rachel O’Donnell