About Dr. Khaldoun Tabbah. More than 30 years of working experience as Pulmonologist, Internist and Faculty Associate Professor of Chest & Internal Medicine in United Kingdom, Syria and United Arab Emirates. Trained at Southampton General Hospital, England, UK, and hold Doctorate of Medicine Degree from University of Southampton, UK, since 1999, and Internal Medicine Masters from University of Aleppo, Syria. Dr. Khaldoun Has published more than 50 articles (alone or with collaborators) in index international journals, authored 2 chapters in respiratory medicine text books and medical encyclopedia, and presented more than 25 lectures at national and international conferences. His main interest research is in asthma and allergy disorders. Dr. Khaldoun is a Member of European, Emirate, and Syrian Respiratory Societies.
Summary Background Indoor air pollution from a range of household cooking fuels has been implicated in the development and exacerbation of respiratory diseases. In both rich and poor countries, the effects of cooking fuels on asthma and allergies in childhood are unclear. We investigated the association between asthma and the use of a range of cooking fuels around the world. Methods For phase three of the International Study of Asthma and Allergies in Childhood (ISAAC), written questionnaires were self-completed at school by secondary school students aged 13–14 years, 244 734 (78%) of whom were then shown a video questionnaire on wheezing symptoms. Parents of children aged 6–7 years completed the written questionnaire at home. We investigated the association between types of cooking fuels and symptoms of asthma using logistic regression. Adjustments were made for sex, region of the world, language, gross national income, maternal education, parental smoking, and six other subject-specific covariates. The ISAAC study is now closed, but researchers can continue to use the instruments for further research. Findings Data were collected between 1999 and 2004. 512 707 primary and secondary school children from 108 centres in 47 countries were included in the analysis. The use of an open fire for cooking was associated with an increased risk of symptoms of asthma and reported asthma in both children aged 6–7 years (odds ratio [OR] for wheeze in the past year, 1·78, 95% CI 1·51–2·10) and those aged 13–14 years (OR 1·20, 95% CI 1·06–1·37). In the final multivariate analyses, ORs for wheeze in the past year and the use of solely an open fire for cooking were 2·17 (95% CI 1·64–2·87) for children aged 6–7 years and 1·35 (1·11–1·64) for children aged 13–14 years. Odds ratios for wheeze in the past year and the use of open fire in combination with other fuels for cooking were 1·51 (1·25–1·81 for children aged 6–7 years and 1·35 (1·15–1·58) for those aged 13–14 years. In both age groups, we detected no evidence of an association between the use of gas as a cooking fuel and either asthma symptoms or asthma diagnosis. Interpretation The use of open fires for cooking is associated with an increased risk of symptoms of asthma and of asthma diagnosis in children. Because a large percentage of the world population uses open fires for cooking, this method of cooking might be an important modifiable risk factor if the association is proven to be causal.
The aim of these clinical standards is to aid the diagnosis and management of asthma in low resource settings in low- and middle-income countries (LMICs). CONCLUS ION: These first consensus-based clinical standards for asthma management in LMICs are intended to help clinicians provide the most effective care for people in resource-limited settings.