Lung function decrement with arsenic exposure to drinking groundwater along River Indus: a comparative cross-sectional study
This study was designed to determine the association between chronic arsenic exposure through drinking groundwater and decrement in lung function, particularly among individuals who do not have signs of arsenic lesions, among an adult population. This was a comparative cross-sectional study conducted during the months of January to March 2009. One hundred participants ≥15 years of age in each group, i.e. exposed (≥100 μg/l) and unexposed (≤10 μg/l) to arsenic, determined by testing drinking water samples (using portable kits), were compared for effects on lung function using spirometry. A structured and validated questionnaire was administered. Examination for arsenic skin lesions was also done. There was a decline in the mean adjusted FEV1 of 154.3 ml (95% CI: −324.7, 16.0; p = 0.076), in mean adjusted FVC of 221.9 ml (95% CI: −419.5, −24.3; p = 0.028), and in FEV1/FVC ratio of 2.0 (95% CI: −25.3, 29.4; p = 0.884) among participants who were exposed to arsenic compared to those unexposed. A separate model comprising a total of 160 participants, 60 exposed to arsenic concentrations ≥250 μg/l and 100 unexposed at arsenic concentrations of ≤10 μg/l, showed a decrement in mean adjusted FEV1 of 226.4 ml (95% CI: −430.4, −22.4; p = 0.030), in mean adjusted FVC of 354.8 ml (95% CI: −583.6, −126.0; p = 0.003), and in FEV1/FVC ratio of 9.9 (95% CI: −21.8, 41.6; p = 0.539) among participants who were exposed to arsenic in drinking groundwater. This study demonstrated that decrement in lung function is associated with chronic exposure to arsenic in drinking groundwater, occurring independently, and even before any manifestation, of arsenic skin lesions or respiratory symptoms. The study also demonstrated a dose-response effect of arsenic exposure and lung function decrement.
KeywordsArsenic Groundwater Lung function decrement Respiratory symptoms Pakistan
We would like to thank Dr. Amin S. Pethani and Dr. Aysha Zahidie for helping in editing of the study questionnaire. We would also like to acknowledge the support of study participants who gave their time and effort to conduct spirometry.
- Ahmad, T., Kahlown, M. A., Tahir, A., & Rashid, H. (2004). Arsenic an emerging issue: Experience from Pakistan. People-centered approaches to water and environmental sanitation. In Thirtieth WEDC international conference, 25–29 October 2004 (pp. 459–466). Vientiane: Lao PDR, WEDC.Google Scholar
- Arain, M. B., Kazi, T. G., Baig, J. A., Jamali, M. K., Afridi, H. I., Shah, A. Q., et al. (2009). Determination of arsenic levels in lake water, sediment, and foodstuff from selected area of Sindh, Pakistan: Estimation of daily dietary intake. Food and Chemical Toxicology, 47, 242–248.CrossRefGoogle Scholar
- Brodkin, C. A., Barnhart, S., Anderson, G., Checkoway, H., Omenn, G. S., & Rosenstock, L. (1993). Correlation between respiratory symptoms and pulmonary function in asbestos-exposed workers. The American Review of Respiratory Disease, 148, 32–37.Google Scholar
- Buschmann, J., Berg, M., Stengel, C., Winkel, L., Sampson, M. L., Trang, P. T., et al. (2008). Contamination of drinking water resources in the Mekong delta floodplains: Arsenic and other trace metals pose serious health risks to population. Environment International, 34, 756–764.CrossRefGoogle Scholar
- Chen, Y., Parvez, F., Gamble, M., Islam, T., Ahmed, A., Argos, M., et al. (2009). Arsenic exposure at low-to-moderate levels and skin lesions, arsenic metabolism, neurological functions, and biomarkers for respiratory and cardiovascular diseases: Review of recent findings from the health effects of arsenic longitudinal study (HEALS) in Bangladesh. Toxicology and Applied Pharmacology, 239, 184–192.Google Scholar
- De, B. K., Majumdar, D., Sen, S., Guru, S., & Kundu, S. (2004). Pulmonary involvement in chronic arsenic poisoning from drinking contaminated ground-water. The Journal of the Association of Physicians of India, 52, 395–400.Google Scholar
- Federal Bureau of Statistics, Statistics Division, Government of Pakistan. (2007). Pakistan social and living standards measurement survey (PSLM) 2006–07. National/provincial. Islamabad. Dec 2007.Google Scholar
- Ferreccio, C., Gonzalez Psych, C., Milosavjlevic Stat, V., Marshall Gredis, G. & Sancha, A. M. (1998). Lung cancer and arsenic exposure in drinking water: A case-control study in northern Chile. Cad Saude Publica, 14 (Suppl 3), 193–198.Google Scholar
- Ferris, B. G. (1978). Epidemiology standardization project (American thoracic society). The American Review of Respiratory Disease, 118(6), 1–120.Google Scholar
- Fewtrell, L., Fuge, R., & Kay, D. (2005). An estimation of the global burden of disease due to skin lesions caused by arsenic in drinking water. Journal of Water Health, 3, 101–107.Google Scholar
- Government of Pakistan, Pakistan Environmental Protection Agency (Ministry of Environment). (2008). National standards for drinking water quality. Islamabad. June 2008. Available from: http://www.environment.gov.pk/act-rules/DWQStd-MAY2007.pdf. Accessed July 2010.
- Government of Sindh. (2000). Part 1. The Sindh government gazette extension November 22, 2000-1289-AV. Delimination of Union Councils Boundaries; District Khairpur, Taluka Gambat. Karachi, Government of Sindh, November 2000.Google Scholar
- Haque, R., Mazumder, D. N., Samanta, S., Ghosh, N., Kalman, D., Smith, M. M., et al. (2003). Arsenic in drinking water and skin lesions: Dose-response data from West Bengal, India. Epidemiology, 14, 174–182.Google Scholar
- Ichinose, Y., Kasuga, I., Minemura, K., Kiyokawa, H., Utsumi, K., Torii, Y., et al. (1993). Early detection of chronic obstructive pulmonary disease by following individual annual changes in lung function. Nihon Kyobu Shikkan Gakkai Zasshi, 31, 1109–1113.Google Scholar
- Kazi, T. G., Arain, M. B., Baig, J. A., Jamali, M. K., AFRIDI, H. I., JALBANI, N., et al. (2009). The correlation of arsenic levels in drinking water with the biological samples of skin disorders. Science of the Total Environment, 407, 1019–1026.Google Scholar
- Kinniburgh, D. G., & Smedley, P. L. (Eds). (2001). Arsenic contamination of groundwater in Bangladesh. BGS Technical report WC/00/19, vol 1: Summary. Keyworth: British Geological Survey.Google Scholar
- Mazumder, D. N. (2007). Effect of drinking arsenic contaminated water in children. Indian Pediatrics, 44, 925–927.Google Scholar
- Mukherjee, S. C., Rahman, M. M., Chowdhury, U. K., Sengupta, M. K., Lodh, D., Chanda, C. R., et al. (2003). Neuropathy in arsenic toxicity from groundwater arsenic contamination in West Bengal, India. Journal of Environmental Science and Health. Part A, Toxic/Hazardous Substances & Environmental Engineering, 38, 165–183.CrossRefGoogle Scholar
- National Research Council. (2001). Subcommittee to update the 1999 arsenic in drinking water report, national research council. Arsenic in drinking water: 2001 update (pp. 24–74). Washington, DC: National Academies Press.Google Scholar
- Parvez, F., Chen, Y., Brandt-Rauf, P. W., Bernard, A., Dumont, X., Slavkovich, V., et al. (2008). Nonmalignant respiratory effects of chronic arsenic exposure from drinking water among never-smokers in Bangladesh. Environmental Health Perspectives, 116, 190–195.Google Scholar
- Parvez, F., Chen, Y., Brandt-Rauf, P. W., Slavkovich, V., Islam, T., Ahmed, A., et al. (2010). A prospective study of respiratory symptoms associated with chronic arsenic exposure in Bangladesh: Findings from the health effects of arsenic longitudinal study (HEALS). Thorax, 65, 528–533.CrossRefGoogle Scholar
- Sood, A., Dawson, B. K., Henkle, J. Q., Hopkins-Price, P., & Quails, C. (2007). Effect of change of reference standard to NHANES III on interpretation of spirometric ‘abnormality’. International Journal of Chronic Obstructive Pulmonary Disease, 2, 361–367.Google Scholar
- Standardization of Spirometry, 1994 update. (1995). American thoracic society. American Journal of Respiratory and Critical Care Medicine, 152(3), 1107–1136.Google Scholar
- Tager, I. B., Hanrahan, J. P., Tosteson, T. D., Castile, R. G., Brown, R. W., Weiss, S. T., et al. (1993). Lung function, pre- and post-natal smoke exposure, and wheezing in the first year of life. The American Review of Respiratory Disease, 147, 811–817.Google Scholar
- Taussig, L. M., Wright, A. L., Holberg, C. J., Halonen, M., Morgan, W. J. & Martinez, F. D. (2003). Tucson children’s respiratory study: 1980 to present. J Allergy Clin Immunol, 111, 661–675 (quiz 676).Google Scholar
- Tsuda, T., Babazono, A., Yamamoto, E., Kurumatani, N., Mino, Y., Ogawa, T., et al. (1995). Ingested arsenic and internal cancer: A historical cohort study followed for 33 years. American Journal of Epidemiology, 141, 198–209.Google Scholar
- World Health Organization. (2001). IPCS environmental health criteria 224 arsenic and arsenic compounds. Geneva: International Program on Chemical Safety, World Health Organization.Google Scholar
- World Health Organization. (2008). Guidelines for drinking-water quality: Third edition, incorporating the first and second addenda, vol. 1, recommendations. Geneva, Switzerland: World Health Organization.Google Scholar
- World Health Organization. (2009). Arsenic in drinking water: Global scenario [online] 2001 May last update [cited 2009 August 5]. Available from: URL: http://www.who.int/mediacentre/factsheets/fs210/en/index.html.