TABLE 3.

Effects on respiratory health and exposure to pesticides in the general population

First author [ref.]	Location	Study design	Summary of method				Results
			Population characteristics	Pesticides of interest	Exposure assessment	Health outcomes
Balluz [44]	USA	Cross-sectional	117 employees of a health centre in Georgia, 94% women, aged: 21–68 years	Malathion, Organochlorines including DDT: stored, handled and used in the fight against mosquitoes	Environmental sampling of pesticides in the building: Malathion (110 µg·g−1); DDT (24 µg·g−1) Measures of 17 chlorinated pesticides in serum and urine of employees (concentrations below 95% limit for the reference range for the US population)	Self-reported occurrence and severity of respiratory illnesses and symptoms	Duration of employment (at least 3 years) significantly associated with bronchitis (OR 4.3, 95% CI 1.7–11.0) and sinusitis (OR 3.7, 95% CI 1.5–8.7) No association between health complaint and pesticide levels in serum and urine
Ames [45]	USA	Retrospective study	39 subjects who were residents living near farms where paraquat was applied and 172 controls living in areas remote from spraying	Paraquat	Living near farms where paraquat was applied (an area of ∼0.5 miles) Self-reported perception of odour during the 2 weeks of study period	Self-reported symptoms during the 2-week study period	Significant increased risk for cough (RR 2.60; p<0.001) and wheezing (RR 3.04; p<0.01, Chi-squared) in the paraquat-exposed group
Karpati [46]	USA	Retrospective study after a mosquito eradication programme	62 827 visits for asthma in the ED of hospitals in New York, study period, mean age: 34 years	Pyrethroid insecticides sprayed in New York City during July–September 2000 to control mosquito vectors of West Nile virus	None	Data obtained from the New York City Health and Hospitals Corporation for ED visits for asthma during pesticide spraying period	No significant association between pesticide spraying days and daily rates of asthma visits (RR 0.92, 95% CI 0.80–1.07)
O'Sullivan [47]	USA	Retrospective study after a mosquito eradication programme	1 318 patients with a diagnosis of asthma in the ED of Lincoln hospital (South Bronx, NY) during 1997, 1998 and 1999	Malathion (organophosphate insecticide) and andresmethrin (pyrethroid insecticide) sprayed during the mosquito eradication programme in South Bronx in September 1999	None	Adult and paediatric asthma ED admissions during the 4 days (September 1999) of the mosquito eradication programme	No significant differences in patient ED asthma admissions between spraying and non-spraying days in September 1999 No significant difference between the number of ED asthma admissions in September 1999 compared with 1997 and 1998
Zhang [48]	China	Cross-sectional	22 528 rural adults, 48.7% men, age ≥15 years	Insecticides	Face-to-face questionnaire to obtain information on regular occupational and environmental exposure to chemicals (insecticides)	Face-to-face questionnaire (IUATLD questionnaire) about respiratory symptoms during the past 12 months	Exposure to insecticides associated with higher prevalence of chronic cough (OR 2.2, 95% CI 1.4–3.3), asthma attack (OR 1.9, 95% CI 1.3–2.9) and wheeze (OR 1.8, 95% CI 1.2–2.6)
LeVan [49]	Singapore	Prospctive cohort (Singapore Chinese Health Study, SCHS)	52 325 subjects, 42.6% men, age: 45–75 years	Vapour exposure including pesticides	None	Follow-up phone questionnaire based on ATS-DLD: respiratory symptoms, self-report of physician-diagnosed adult-onset asthma and respiratory outcomes in general	Occupational pesticide exposure associated with adult-onset asthma (OR 1.69, 95% CI 1.13–2.52)

DDT: dichlorodiphenyl trichloroethane; RR: relative risk; ED: emergency department; IUATLD: International Union Against Tuberculosis and Lung Disease; ATS-DLD: American Thoracic Society Division of Lung Disease.