Avoidance of Inhaled Pollutants and Irritants in Asthma from a Salutogenic Perspective

Figures & data

Figure 1 Participation of pollutants and inhaled irritants in inflammation of the respiratory epithelium in different asthma endotypes.

Figure 2 Article search strategy flowchart.

Table 1 Substances Identified in the Home Environment That Can Affect the Airways

Substances	Products Found	Risk Presentation	Effects on the Airways
Major smoke compounds: carbon and nitrogen oxides, particulate matter, nitrosamines, aromatic hydrocarbons and nicotine.	Tobacco or electronic cigarette	Exhaled gases	Intense inflammatory reaction; allergic sensitization; changes in lung function.
Particulate matter (PM0.1), (PM2.5), (PM10)	Combustion of biomass (coal and firewood) at home	Very fine particles of solids or liquids suspended in ambient air	Oxidative stress with inflammation; changes in lung function; increase in Th2 profile pro-inflammatory cytokines.
Chemicals in household cleaning products	Household cleaning products	In spray or volatile form	Oxidative stress with inflammation; allergic sensitization; irritative inflammatory reaction; changes in lung function.
Fluorinated hydrocarbons (hydrofluoric acid)	Refrigerators and air conditioning systems when exposed to biomass combustion	Colorless, compressed and odorous gases	Reaction; changes in lung function: drop in FEV1.
Perfume chemical fragrances	Perfumes and deodorants	In spray or volatile form	Minimal irritant inflammatory reaction.
DBPs in swimming pools: monochloramines dichloramines trichloramines (NCl3), trihalogenomethanes haloacetic acid	Chlorine and derivative compounds used in swimming pools	Liquid and gaseous	Irritant inflammatory reaction; changes in lung function: drop in FEV1.
Exposure to pesticides at home	Acaricides, fungicides, herbicides, insecticides, rodenticides and repellents	Liquid, solid and gaseous	Irritant inflammatory reaction; changes in lung function: drop in FEV1.

Note: Selected articles.^16–26

Abbreviations: FEV1, forced expiratory volume in 1s; FVC, forced vital capacity; DBPs, swimming pool disinfection by-products.

Table 2 Characteristics of Chemical Substances Found in Residential Cleaning Products

Chemical Substances	Main Group	Share Ownership	Effect on Asthma
Citric acid	Calcium binders	Irritating	Exacerbation
Nitrilotriacetic acid	Calcium binders	Irritating	Exacerbation
Ethylenediamine acid tetraacetic acid (EDTA)	Calcium binders	Irritating and sensitizing	Exacerbation and Induction
Hypochlorite/sodium	Chlorine substances	Irritating	Exacerbation
Benzalkonium chloride	Chlorine substances	Irritating and sensitizing	Exacerbation and Induction
Monoethanolamine	Amines	Irritating and sensitizing	Exacerbation and Induction
Diethylene glycolamine	Amines	Irritating	Exacerbation
Alkyldimethyl amino oxide	Amines	Irritating	Exacerbation
Methylisothiazolinone	Isothiazolinones	Irritating	Exacerbation
Benzisothiazolinone	Isothiazolinones	Irritating	Exacerbation
Chlormethylisothiazolinone	Isothiazolinones	Irritating	Exacerbation
P- Sodium cumenesulfonate	Sulfonates and sulfamic acid	Irritating	Exacerbation
Carmoisine	Sulfonates and sulfamic acid	Irritating	Exacerbation
Sulfamic acid	Sulfonates and sulfamic acid	Irritating	Exacerbation
Salicylic acid	Salicylic acid and the like	Irritating and sensitizing (?)	Exacerbation and Induction (?)
Sodium benzoate	Salicylic acid and the like	Irritating and sensitizing (?)	Exacerbation and Induction (?)
Propylene glycol	Aliphatic alcohols and acids	Irritating and sensitizing (?)	Exacerbation and Induction (?)
Glycerol	Aliphatic alcohols and acids	Irritating and sensitizing (?)	Exacerbation and Induction (?)
Propylidinetrimethanol	Aliphatic alcohols and acids	Irritating and sensitizing (?)	Exacerbation and Induction (?)
Lactic acid	Aliphatic alcohols and acids	Irritating	Exacerbation
Malate disodium	Aliphatic alcohols and acids	Irritating	Exacerbation
Bronopol	Substances with no defined group	Irritating and sensitizing (?)	Exacerbation and Induction (?)
Morpholine	Substances with no defined group	Irritating	Exacerbation
Benzilic alcohol	Substances with no defined group	Irritating	Exacerbation

Notes: (?) Little evidence as possible sensitizers or inducers of asthma. Adaptation of Hadrup ‘s study et al.⁴⁰

Figure 3 Home scenario with possible allergens, pollutants and harmful inhalation irritants for the child with asthma, highlighting the role of the caregiver, under the salutogenic perspective.

Hadrup N, Frederiksen M, Wedebye EB, et al. Asthma‐inducing potential of 28 substances in spray cleaning products—assessed by quantitative structure activity relationship (QSAR) testing and literature review. J Appl Toxicol. 2022;42(1):130–153. doi:10.1002/jat.4215

 PubMed Web of Science ®Google Scholar