After careful consideration, the American Thoracic Society canceled its annual meeting that was to take place in Philadelphia, Pennsylvania from May 15-20, because of the ongoing coronavirus disease 2019 (COVID-19) pandemic. Although the live events will not proceed as planned, our readers can still find coverage of research that was scheduled to be presented at the meeting. A virtual event is being planned for later this year.

Prenatal and early life exposure to household air pollution may affect lung function development and lead to an increase in airway resistance, according to findings intended to be presented at the American Thoracic Society (ATS) International Conference. (Select research is slated to be presented in a virtual format later this year.)

The risk of household air pollution exposure as a result of burning solid fuels on cookstoves affects 2.8 billion people, which can cause significant respiratory morbidity and mortality over the course of a lifetime. However, the effects of prenatal and early childhood household air pollution exposure on childhood lung function are unknown. Therefore, researchers sought to identify the risks associated with early life household air pollution exposure using the Ghana Randomized Air Pollution and Health Study (GRAPHS). They conducted carbon monoxide (CO) assessments and impulse oscillometry (IOS) testing. Associations between the CO exposures and IOS measures were then compared with generalized estimating equations (GEE).

Researchers studied a total of 572 children (49% boys) aged 4.1±0.35 years and performed quality CO and IOS testing. The association between prenatal and early childhood household air pollution exposure was investigated through serial 72-hour personal CO assessments, and lung function was determined through IOS testing. Multivariate analysis examined data from the assessments with adjustments made for the children’s age, height, weight, and sex, respectively. Researchers initially examined the serial results together and then independently.

According to GEE models, children aged 4 years who were exposed to household air pollution prenatally and early in life had increased airway resistance at 5 hertz (R5Hz, Beta=0.18 cmH2O/[L/s], 95% CI, 0.07-0.29; P <.001) and 20 Hertz (R20Hz, Beta=0.07 cmH2O/[L/s], 95% CI, 0.01-0.14; P =.03) as measured by IOS testing. Researchers noted a similar increase in the children’s reactance area (AX, Beta=0.13 cmH2O/[L/s], 95% CI, 0.06-0.19; P <.001) per 1 ppm increase in CO exposure.

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When prenatal and early childhood exposures were analyzed separately, researchers noted that prenatal associations had a consistently larger effect size compared with early childhood. “Further, prenatal CO demonstrated a trend toward significance with an increase in the difference between resistance at 5 and 20 hertz.” The increase in exposure directly altered lung development, which resulted in increased airway resistance.

The researchers concluded that, “[g]iven the established importance on early life lung function on respiratory and non-respiratory morbidity over the life course, these findings support the need to reduce [household air pollution] exposures beginning prenatally.”


Lee A, Kaali S, Jack D, et al. Prenatal and early childhood household air pollution exposure alters lung function at age four years: evidence from GRAPHS. Am J Respir Crit Care Med. 2020;201:A4616.

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This article originally appeared on Pulmonology Advisor