Examination of the data suggests that the lesions associated with pollution exposure are mostly confined to the more distal segments of the airway tract. The alterations in the pollution-exposed group were dominated by an increase in the inflammatory cells in the bronchiolar walls, and consequently, bronchio-lar wall thickening mainly due to fibrosis and distortion of airway lumen. These alterations are superimposed to those classically ascribed to long-term exposure to cigarette smoke. However, the inspection of Figure 1 clearly indicates that the extent of bronchiolar damage and carbon deposition was greater in individuals living in the polluted area in comparison to those living in regions without significant air pollution. canadian family pharmacy
The estimated air pollution effects are not likely to be substantially biased due to confounding of smoking or other factors. Similar effects were observed even when the groups were disaggregated by smokers vs nonsmokers. Occupational exposure is a potential confounder since it may induce histopathologic lesions similar to those observed in those individuals exposed to ambient air pollution. In the present study, we considered a positive history of occupational exposure whenever the family reported previous work in industries with high occupational exposure, such as civil construction and agricultural activities (cooking fuel use, wood burning, and processes related to burning for harvesting purposes, such as in the sugar cane industry). In the state of Sao Paulo, the use of coal or wood for cooking is almost negligible. However, if it occurred in our series, it is necessarily restricted to the agricultural area. Whether cooking represents a bias in our study, it is happening more intensely in the control and not in the polluted region; thus, our results would be hardly due to cooking. Agricultural processes in Brazil are classically associated with occupational lung disease, especially because of the use of agrotoxics and burning of the vegetation for planting or harvesting. The background of occupational history was similar in both groups. Furthermore, the estimated effects of air pollution were nearly the same after controlling for occupational exposure, passive smoking, age, and sex in the regression model.
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