Respiratory Changes due to Long-term Exposure to Urban Levels of Air Pollution: Discussion

In: Pulmonary function

19 May 2014

Respiratory Changes due to Long-term Exposure to Urban Levels of Air Pollution: DiscussionThis article was aimed at verifying the possible differences in histopathologic changes seen in the lungs of relatively young individuals who reside in an area where there is a great deal of particulate air pollution as compared with a more rural area where the air quality is presumably far better. buy zyrtec online

Considering the importance of such information, the limitations of our database must be fully identified. It is impossible to properly address all the confounding variables in a study like ours. Thus, most of the information coming from the past events, not related to pollution, cannot be fully controlled in our series. Additionally, one has to consider the limitations of questionnaires filled in at the time of a necropsy performed due to a violent cause, especially when culturally, the relatives are somewhat underprivileged, as commonly occurs in a developing country. This was the most critical and limiting point of the study. However, we preferred a better evaluation of smoking, occupational, and residence background, rather than increasing the size of the sample without reliable information. In addition, there are ethical aspects involved, since it is not possible to perform a systematic sampling study without informed consent of the closest relatives of the victims. In reality, we believe that any attempt to perform a clustered stratified sampling representative of the overall population would fail, because of the circumstances associated with a tragic death and the distance between the study sites that impeded us from staying permanently in the regions where patients were selected. Thus, we believe that the only way to confirm the long-term effects of air pollution on lung histopathology will be by the reproducibility of studies performed across different exposure backgrounds and carried out by different groups. The same problem was previously faced by human epidemiologic studies, which by means of ecologic approaches, reported significant acute effects of air pollution on mortality. Although association does not mean causality, the growing number of coherent studies provides enough evidence to support plausibility. Thus, it was impossible to ascribe causality in isolated studies like ours, but they may get stronger by the reproduction of the results by different groups in different regions. Thus, we probably will do better by stating more clearly the limitations of our data set rather than by defining precisely the source of noise coming from our exposure history.

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