IISection
5.3.2.5 Rise in Copd
COPD is characterized by symptoms of chronic bronchitis (presence of cough and expectorations on most of the days for at least three months in a year for two con- secutive years or more) and reduced lung function (FEV1 and FEV1/FVC). COPD is a major public health concern around the globe. It is ranked 12th as a burden of disease worldwide and is projected to rank 5th by the year 2020 in terms of number of deaths and loss of quality of life (Varkey, 2004). COPD was found in 6.3% of biomass users compared with 2.1% in controls (Table 5.4).
fIguRe 5.4 Photomicrographs of sputum samples of biomass users showing abundance of particle-laden alveolar macrophages (a), neutrophilia (b), increased eosinophil number (stained orange, c) and goblet cell hyperplasia (d), indicating high particulate pollution expo- sure, inflammation of the airways, bronchial allergy, and mucus hypersecretion, respectively.
Pap-stained ×200 (b) ×1000 (a,c,d).
5.3.3 Hematological, immunological, and cardioVaScular cHangeS Biomass-using women had increased WBC, neutrophil and eosinophil counts, and lowered hemoglobin and erythrocyte levels than LPG-using controls. However, no significant difference was recorded in platelet, monocyte, and lymphocyte counts between biomass users and controls (Table 5.5). The blood smear of 18% of biomass users displayed anisocytosis (change in red cell size) and 23% had poikilocytosis (change in red cell shape) against 9% and 12% of age-matched LPG-using controls.
Abundance of “target” cells was found in 17% of biomass users compared with 5%
of controls. Toxic granulation of neutrophils, an indication of bacterial infection and inflammation, was found in 81% of biomass users in contrast to 29% of LPG users.
Chronic exposure of women to biomass smoke may alter the body’s immune defense. We found alterations in lymphocyte subsets in biomass-using women of Eastern India. They had 17% reduction in absolute number of CD4+ T-helper cells and 14% fall in CD19+ B-lymphocytes but 31% increase in CD16 + CD56+ natural
table 5.4
prevalence (%) and severity of Copd among biomass using Women of West bengal
Copd severity
prevalence (%)
lpg users (n 650) biomass users (n 1260)
Mild 1.1 1.6*
Moderate 0.5 2.1*
Severe 0.5 1.6*
Very severe 0.1 1.0*
Overall 2.2 6.3*
*p < 0.05.
table 5.5
hematological Changes in biomass users
lpg users biomass users Hemoglobin (g/dL) 11.5 ± 1.2 10.9 ± 1.1*
RBC (106/µL) 4.1 ± 0.3 3.8 ± 0.4*
Platelet (105/µL) 2.3 ± 0.4 2.2 ± 0.4
WBC/µL 7524 ± 482 8350 ± 518*
Neutrophil/µL 4244 ± 311 4701 ± 367*
Lymphocyte/µL 2528 ± 205 2488 ± 203
Monocyte/µL 211 ± 27 219 ± 29
Eosinophil/µL 497 ± 54 919 ± 105*
Results are mean ±SD; *p < 0.05 compared with LPG users.
killer cells and 12% rise in CD8+ T-lymphocytes in peripheral blood compared with LPG users, suggesting changes in immune defense (Table 5.6). Air pollutants commonly found in biomass smoke have been shown to cause hematological altera- tions (Ray et al., 2003) and suppression of the lung’s immunity in animal and human studies (Chang et al., 1990; Fujii et al., 2001; Mukae et al., 2001). Lymphocytes are the key players in maintaining the body’s surveillance over infiltrating pathogens.
Among all the air pollutants, B(a)P, found in large quantities in biomass smoke, is particularly important because it causes immune suppression by downgrading B cell-mediated humoral immunity (Hardin et al., 1992; Szezeklik et al., 1994).
The expression of CD11b/CD18, the activation markers of neutrophils and mono- cytes, was significantly increased in women who were chronically exposed to biomass smoke. The mean fluorescence intensity (MFI) for CD 11b on neutrophils was elevated from 683.5 ± 85.9 (SD) in controls to 1150.2 ± 143.2 (p < 0.001) in biomass users (Figure 5.5). MFI of CD18 on neutrophils was also increased from 385.1 ± 56.4 to 568.7 ± 64.4 (p < 0.001). Similarly, the MFI of CD11b and CD18 on peripheral
1150
LPG users Biomass users 683
1400 1200 1000 800
Individuals (%)
600 400 200 0
fIguRe 5.5 Marked increase in mean fluorescence intensity (MFI) of CD11b expression on neutrophil surface of biomass users suggesting activation of these cells.
table 5.6
lymphocyte subsets in peripheral blood of biomass and lpg-using Women
lymphocyte subtype lpg users biomass users
CD4 + T cell (%) 45.4 ± 3.8 38.3 ± 3.5*
CD4 + T cell/µL 1148 ± 98 953 ± 87*
CD8 + T cell (%) 26.6 ± 2.7 30.6 ± 3.2
CD8 + T cell/µL 672 ± 68 761 ± 73*
CD19 + B cell (%) 15.7 ± 1.7 13.7 ± 1.8
CD19 + B cells/µL 397 ± 46 341 ± 50*
CD16 + CD56 + NK cell (%) 11.8 ± 1.7 17.3 ± 1.8*
CD 16 + 56 + NK-cells/µL 298 ± 44 430 ± 52*
Results are mean ±SD; *p < 0.05 compared with LPG users.
blood monocytes of biomass users was increased by 50% and 62%, respectively when compared with that of controls. The present findings along with that of earlier ones (Ray et al., 2006) suggest functional activation and migration of inflammatory cells from airways to the tissues of women chronically exposed to biomass smoke.
Cardiovascular disease (CVD) is well known for its association with active and passive smoking and outdoor air pollution in the Western world. In comparison, little is known about its association with IAP from biomass burning in the developing countries. We found remarkable increase in platelet activity, a risk factor for CVD, in women who cook regularly with biomass fuels. Compared with 2.2% of P-selectin- positive circulating platelets of LPG users, biomass users had 6.3% P-selectin- expressing activated platelets in peripheral blood (Figure 5.6). Similarly, expression of soluble P-selectin (GMP-140) in plasma was significantly increased in biomass users (Figure 5.6). Platelet activation was accompanied by a sharp rise in the percentage of neutrophil–platelet (9.1% vs. 3.8%) and monocyte–platelet aggregates (6.6% vs. 2.7%).
Platelet–leukocyte complexes enable leukocytes to be involved in hemostasis and thrombosis. CD11b expression is intimately related to the levels of plasma markers of coagulation activation and increased circulating leukocyte–platelet aggregates repre- sent an additional prothrombotic mechanism, and a risk factor for thrombosis, because they promote the formation of fibrin via induction of tissue factor expression on mono- cytes, release of superoxide anions, and production of proinflammatory cytokines from polymorphonuclear leukocytes (PMN), which, in turn, augment platelet activa- tion and modulate the coagulant properties of the endothelium. Taken together, the findings suggest a greater risk factor of CVD in biomass users.
5.3.4 adVerSe effectSon female reproductiVe SyStem