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Title: Indoor air pollution from biomass fuel smoke and its effect on respiratory health, in a population at risk of HIV related pneumonia
Author: Fullerton, Duncan Gordon
ISNI:       0000 0004 2732 3838
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2011
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Background: Three billion people use biomass fuel (BMF) as the main source of household energy. Indoor air pollution (lAP) from BMF smoke is associated with lower respiratory tract infections and low birth weight in children; COPD and TB in adults. 3 hypotheses were tested in this thesis: IAP levels in Malawian homes are high; BMF smoke exposure is associated with impaired lung function; Particulate matter exposure (PM) impairs alveolar macrophage function. Methods: In urban and rural homes in Malawi, 4 different air sampling devices were located to measure levels of PM and carbon monoxide. Questionnaire data were collected to identify risk factors for COPD; Spirometry was measured. In Malawi and the UK adult volunteers underwent bronchoalveolar lavage (BAL). The in vivo human alveolar macrophage (HAM) appearance was reproduced in vitro by challenging macrophages with PM. Dose and time dependent experiments were performed in vitro to assess PM phagocytosis by HAM and monocyte derived macrophages (MD M). The effect on inflammatory cytokines (IL-6 and IL-8) secretion by HAM and MDM in vitro exposure to PM was measured by ELISA. HAM functions were assessed using a novel reporter bead flow cytometry assay. Oxidative burst, proteolysis and phagocytic activity were compared by HAM PM load, using a novel image analysis method. Results: In 80% of 74 homes sampled, the PM levels measured were four times greater than the WHO safe level for indoor air quality. 374 individuals performed spirometry. Data showed that wood smoke and lower socioeconomic status are both associated with impaired lung function. PM load in HAM was associated with the type of BMF used. An increase in the dose and incubation time of PM, led to greater ingestion of PM by MDM and HAM. Secretion of IL-6 and IL-8 was increased by increasing the dose of PM. HAM produced more IL-6 and IL-8 compared to MDM. In HAM, impaired oxidative burst was observed with higher PM load. Conclusion: This thesis is the first description of IAP and the effect it has on lung function in Malawi. It explores an in vitro model and increases the understanding of the mechanisms behind lung damage. It describes a biomarker that can be used to support epidemiological associations as well as to plan effective and appropriate interventions to reduce exposure.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral