Jon G Ayres

• MD
• Professor Emeritus at University of Birmingham

Background Chronic obstructive pulmonary disease is a major contributor to morbidity, mortality and health service costs but is vastly underdiagnosed. Evidence on screening and how best to approach this is not clear. There are also uncertainties around the natural history (prognosis) of chronic obstructive pulmonary disease and how it impacts on wo...

Background/Aim To study the association between exposure to biomass smoke from cooking fuels and cataract, visual acuity and ocular symptoms in women. Methods We conducted a community-based cross-sectional study among women (≥20 years and without a previous diagnosis of cataract, ocular trauma or diabetes or those taking steroids) from hilly and p...

Background Although around 10% to 15% of COPD burden can be attributed to workplace exposures, little is known about the role of different airborne occupational pollutants (AOP). The main aim of the study was to assess the effect size of the relationship between various AOP, their level and duration of exposure with airflow obstruction (AFO). Meth...

The term ‘occupational and environmental health’ includes any act of emission of any substance, likely to be hazardous in nature, which is either not originally present or is present in a higher concentration than normal in the natural atmosphere. Most air pollutants are generated from human activities (e.g. energy, transportation, industry, agricu...

The environment, both occupational and beyond, can affect health in many ways, adversely as well as beneficially. While to date many of these effects have been well understood, most specifically for the work environment, the importance of the wider environment as a cause of ill health has been less well studied on the basis that there is not much o...

Introduction ‘One-off’ systematic case-finding for COPD using a respiratory screening questionnaire is more effective and cost-effective than routine care at identifying new cases. However, it is not known whether early diagnosis and treatment is beneficial in the longer term. We estimated the long-term cost-effectiveness of a regular case-finding...

Objectives: Air pollution has been associated with increased mortality and morbidity in several studies with indications that its effect could be more severe in children. This study examined the relationship between short-term variations in criteria air pollutants and occurrence of sudden infant death syndrome (SIDS). Design: We used a case-cros...

Background: Several studies have assessed the impact of chronic obstructive pulmonary disease (COPD) on work ability and work productivity; however, this relationship is poorly understood. Aims: To undertake a systematic review to assess the effects of COPD on employment, absenteeism and presenteeism. Methods: A comprehensive search using CINA...

Background Patients with chronic obstructive pulmonary disease (COPD) are more likely to take time off work (absenteeism) and report poor performance at work (presenteeism) compared to those without COPD. Little is known about the modifiable factors associated with these work productivity outcomes. Aim To assess the factors associated with work pr...

Background The association between occupational exposure and COPD reported previously has mostly been derived from studies relying on self-reported exposure to vapors, gases, dust, or fumes (VGDF), which could be subjective and prone to biases. The aim of this study was to assess the strength of association between exposure and COPD from studies th...

Background: Evidence from longitudinal population-based studies relating occupational exposure to the full range of different forms of airborne pollutants and lung function and airway obstruction is limited. Objective: To relate self-reported COPD and lung function impairment to occupational exposure to different forms of airborne chemical pollu...

Background Employment rates among those with chronic obstructive pulmonary disease (COPD) are lower than those without COPD, but little is known about the factors that affect COPD patients’ ability to work. Methods Multivariable analysis of the Birmingham COPD Cohort Study baseline data was used to assess the associations between lifestyle, clinic...

Household Air Pollution (HAP) from biomass cooking fuels is a major cause of morbidity and mortality in low-income settings worldwide. In Nepal the use of open stoves with solid biomass fuels is the primary method of domestic cooking. To assess patterns of domestic air pollution we performed continuous measurement of carbon monoxide (CO) and partic...

Chronic obstructive pulmonary disease (COPD) affects 5–10% of people worldwide, 1 is rising in prevalence 2 and is the third most common cause of death. 3 The annual burden of COPD regarding healthcare (mainly exacerbations resulting in emergency admissions) and societal (predominantly lost productivity) costs was estimated to be around $49.9 billi...

Background: Many individuals with chronic obstructive pulmonary disease (COPD) remain undiagnosed worldwide. Health-care organisations are implementing case-finding programmes without good evidence of which are the most effective and cost-effective approaches. We assessed the effectiveness and cost-effectiveness of two alternative approaches to ta...

Some in vitro studies have indicated a possible link between respiratory syncytial virus (RSV) infection and exposure to Nitric Oxide (NO). However, these studies used much higher NO concentrations than normally found in the ambient environment. This preliminary study explored whether an association was present with short-term exposure to NO in the...

Background: Few studies have assessed long-term effects of particulate matter (PM) with aerodynamic diameter < 2.5 μm (PM2.5) on mortality for causes of cancer other than the lung; we assessed the effects on multiple causes. In Hong Kong, most people live and work in urban or suburban areas with high-rise buildings. This facilitates the estimation...

Little is known about the effect of air pollution on the gastrointestinal (GI) system. We investigated the association between long-term exposures to outdoor fine particles (PM2.5) and hospitalization for peptic ulcer diseases (PUDs) in a large cohort of Hong Kong Chinese elderly. A total of 66,820 subjects aged ≥65 years who were enrolled in all 1...

Introduction: Asthma affects children's quality of life (QoL) but factors associated with QoL are not well understood. Our hypothesis was that there are factors linked to QoL which are amenable to treatment or environmental modification. Methods: QoL was ascertained in a study designed to link environmental exposures to asthma outcomes. Univaria...

Objectives: Inhalation of a cotton-based particulates has previously been associated with respiratory symptoms and impaired lung function. This study investigates the respiratory health of Nepalese textile workers in relation to dust and endotoxin exposure. Methods: A total of 938 individuals from four sectors (garment, carpet, weaving and recyc...

Asthma is common in children worldwide, although its prevalence varies substantially by location. The prevalence of wheeze over a 12-month period ranged from 2.1% to 32.2% in the older age group (13–14 years) and 4.1% to 32.1% in the younger age group (6–7 years) [1]. There is a positive association between current symptoms of asthma in younger and...

A limited number of studies on long-term effects of particulate matter with aerodynamic diameter <2.5 μm (PM2.5) on health suggest it can be an important cause of morbidity and mortality. In Asia where air quality is poor and deteriorating, local data on long-term effects of PM2.5 to support policy on air quality management are scarce. We assessed...

A randomised trial of prenatal multiple micronutrient supplementation in Nepalese women increased birthweight and weight at 2 years of age in offspring, compared to those born to mothers who only received iron and folic acid supplements. Further follow-up of this cohort provided an opportunity to investigate the effect of antenatal multiple micronu...

Long delays from symptom onset to the diagnosis of occupational asthma have been reported in the UK, Europe and Canada and workers are often reluctant to seek medical help or workplace solutions for their symptoms. Reducing this delay could improve workers' quality of life, and reduce the societal cost of occupational asthma. This study aimed to ex...

Introduction Long delays from symptom onset to the diagnosis of occupational asthma have been reported in the UK, Europe and Canada and workers are often reluctant to seek medical help or workplace solutions for their symptoms.1,2 Reducing this delay could improve workers’ quality of life, and reduce the societal cost of occupational asthma. This s...

Introduction Occupational asthma (OA) accounts for 1 in 6 cases of adult-onset asthma and is associated with an estimated societal cost in the UK of £100 million/annum.1 However many workers with OA go undiagnosed or experience a lengthy delay in diagnosis,2 and primary healthcare professionals fail to enquire about patients’ occupations and the ef...

Introduction There is evidence that workplace productivity may be impaired among working patients with COPD. Occupational health (OH) interventions have been effective in improving work productivity in other chronic conditions. However, little is known about the feasibility and acceptability of such interventions among those with COPD. Aim To asses...

Introduction Occupational exposures are associated with the presence of a significant proportion of chronic obstructive pulmonary disease (COPD). The majority of the previous population studies have relied on self-reported exposures to vapours, gases, dusts and fumes (VGDF), which could lead to substantial misclassification. We aim to develop an oc...

Background: Half of the world's population is exposed to household air pollution from biomass burning. This study aimed to assess the relationship between respiratory symptoms and biomass smoke exposure in rural and urban Nepal. Methods: A cross-sectional study of adults (16+ years) in a rural population (n = 846) exposed to biomass smoke and a...

Childhood asthma is a complex condition where many environmental factors are implicated in causation. The aim of this study was to complete a systematic review of the literature describing associations between environmental exposures and the development of asthma in young children. A systematic review of the literature up to November 2013 was condu...

Are maternal vitamin D and E intakes during pregnancy associated with asthma in 10-year-old children? In a longitudinal study of 1924 children born to women recruited during pregnancy, maternal vitamin D intake during pregnancy was assessed by the Food Frequency Questionnaire (FFQ) and vitamin E by FFQ and plasma α-tocopherol; respiratory questionn...

Background: In 2002–04, we did a randomised controlled trial in southern Nepal, and reported that children born to mothers taking multiple micronutrient supplements during pregnancy had a mean birthweight 77 g greater than children born to mothers taking iron and folic acid supplements. Children born to mothers in the study group were a mean 204 g...

Background: Many people with clinically significant chronic obstructive pulmonary disease (COPD) remain undiagnosed worldwide. There are a number of small studies which have examined possible methods of case finding through primary care, but no large RCTs that have adequately assessed the most cost-effective approach. Methods/design: In this stu...

Barrie Patrick Marmion excelled as a clinical microbiologist, medical researcher and academic, mentor to many younger colleagues, and outstanding human being. His professional life and activity stretched more than 70 years, from the era when smallpox, typhoid, and diphtheria were encountered regularly, through to times of gene therapy and routine m...

Background Studies, particularly from low-income and middle-income countries, suggest that exposure to smoke from household air pollution (HAP) may be a risk factor for tuberculosis. The primary aim of this study was to quantify the risk of tuberculosis from HAP and explore bias and identify possible causes for heterogeneity in reported effect size...

Background: Long-term subcutaneous or intravenous infusion of terbutaline has been used to stabilize asthma in patients enduring frequent hospital admissions due to severe asthma despite maximum therapy. However, this treatment is not supported by significant body of evidence. Aim: To study long-term efficacy and safety of using continuous infus...

A systematic review was performed to identify any associations between pesticide exposure and the occurrence (both prevalence and incidence) of airways disease (asthma and chronic obstructive pulmonary disease) and wheezing symptoms. PubMed, MEDLINE, Embase, Scopus, CINAHL, Google Scholar and the Cochrane Database of Systematic Reviews were searche...

Objectives Young adults between 16 and 24 years of age represent only 13% of the working population in the UK, yet they have higher rates of work-related accidents and injuries compared to workers of other age groups. However, little is known about the incidence and risk factors for occupational diseases such as occupational asthma in these individ...

Objectives The UK Biobank study is a sample of 502,682 people aged 40–70, clustered around 22 assessment centres. As part of a project to investigate the causes of COPD and estimate the UK occupational burden, we have assessed the sample’s representativeness with respect to the UK national population, with a view to accounting for potential biases....

Objectives “Traditional” occupational health research has focused on hazard identification in the work environment and the effects on health. Young adults represent 13% of the UK working population, yet little is known about whether pre-existing conditions are associated with their job choice. Method The study was based on data from the Avon Longit...

Background The prolonged use or abuse of voice may lead to vocal fatigue and vocal fold tissue damage. School teachers routinely use their voices intensively at work and are therefore at a higher risk of dysphonia.AimsTo determine the prevalence of voice disorders among primary school teachers in Lagos, Nigeria, and to explore associated risk facto...

The exposure of children to air pollution in low resource settings is believed to be high because of the common use of biomass fuels for cooking. We used microenvironment sampling to estimate the respirable fraction of air pollution (particles with median diameter less than 4 μm) to which 7–9 year old children in southern Nepal were exposed. Sampli...

Background A growing body of evidence suggests that changes in early-life environment can have lasting effects. To investigate this, we followed up children from a double-blind randomised controlled trial of antenatal multiple micronutrient (UNIMAPP) supplementation. The trial showed the intervention group was 77 g heavier at birth and 204 g heavie...

Rapid increases in traffic volumes in countries such as Malaysia may lead to exposure to poor air quality both outdoors and indoors. This study investigated asthma symptoms among Malaysian schoolchildren in relation to indoor and outdoor air pollution in urban and semi-rural settings in a school-based cross-sectional study of 1,952 schoolchildren l...

Secondhand exposure to tobacco smoke is a major cause of ill health in children.1 2 Smoke inhalation damages the developing lung, and the Royal College of Physicians estimates that each year in the UK it is responsible for 300 000 primary care contacts, 9500 hospital admissions, at least 200 cases of bacterial meningitis, and 40 sudden infant death...

To complete a systematic review of the literature describing associations between all environmental exposures and asthma symptoms and exacerbations in children up to mean age of 9 years. Systematic review. Reference lists of identified studies and reviews were searched for all articles published until November 2013 in electronic databases (MEDLINE,...

Background: Exposure to household air pollution (HAP) is associated with respiratory health problems in low and middle income countries. The aim of this study was to assess the association between respiratory symptoms and exposure to wood smoke in rural area of Nepal.Methods: A cross-sectional study of adults (16+ years) in a rural population (n=84...

Background Chronic ill-health may significantly impact on an individual's ability to work. This not only relates to disease severity but also to psychosocial factors such as illness perception and coping strategies.AimsTo explore the factors associated with employment status in adults with cystic fibrosis (CF).Methods Subjects recruited from adult...

Introduction Health related quality of life (HRQoL) tends to be lower among COPD patients, as a result of associated symptoms, comorbidities and the impact of disease on daily life. However, little is known about the association between employment status and HRQoL among COPD patients. Aims We examined the relationships between HRQoL and employment...

Introduction The effect of COPD on work is poorly understood. Approximately 40% are of working age, however, employment rates are lower compared to others. Little is known about characteristics of COPD patients who remain in employment compared to those who do not. Aim To assess which factors are associated with employment status among working age...

Introduction and objectives Guidelines recommend that COPD patients admitted to hospital with an exacerbation should be assessed and considered for supported self-management interventions although it is not known how effective or cost-effective such an intervention would be when instigated during admission or shortly after discharge. We conducted a...

Abstract More than half the world's population still rely on burning biomass fuels to heat and light homes and cook food. Household air pollution, a common component of which is inhalable particulate matter (PM), emitted from biomass burning is associated with increased vulnerability to respiratory infection and an enhanced risk of developing chron...

The increase in asthma and allergies has been attributed to declining exposure to environmental microorganisms. The main source of these is soil, the composition of which varies geographically and which is a major component (40-45%) of household dust. Our hypothesis-generating study aimed to investigate associations between soil components, respira...

Background This study estimates the potential population health burden from exposure to combustion-derived particulate air pollution in domestic settings in Ireland and Scotland. Methods The study focused on solid fuel combustion used for heating and the use of gas for cooking. PM2.5 (particulate matter with an aerodynamic diameter < 2.5 μm) was u...

Background Childhood asthma is a common chronic condition which may be associated with reduced quality of life (QoL). Factors which determine QoL are important to child, parent and clinician and, in particular, factors which are modifiable are of interest and may be amenable to intervention. The aim of the present study was to identify which factor...

Background Low back pain (LBP) is one of the most prevalent occupational health problems in industrialized countries. Little is known about the epidemiology of LBP in developing countries.AimsTo determine the prevalence of LBP among Nepalese textile workers and to investigate the influence of exposure to mechanical and other factors on LBP reportin...

Introduction: Workplace exposures cause a significant proportion of Chronic Obstructive Pulmonary Disease (COPD). Population based studies can improve the understanding of this causal relationship, but are limited in their use by difficulties in accurately defining relevant inhaled workplace exposures.Methods: A SOC 2000 job exposure matrix (JEM) w...

IntroductionIn the absence of measured lifetime exposure data, the majority of studies which investigate the occupational burden of COPD rely on Job Exposure Matrices (JEM) to estimate exposures to airborne pollutants. As part of a project with the UK Biobank we are developing a new COPD JEM; here we report a systematic review of the relevant liter...

Thunderstorm asthma is a term used to describe an observed increase in acute bronchospasm cases following the occurrence of thunderstorms in the local vicinity. The roles of accompanying meteorological features and aeroallergens, such as pollen grains and fungal spores, have been studied in an effort to explain why thunderstorm asthma does not acco...

Introduction Obesity may be important to asthma causation but the relationship between obesity and outcomes within populations of children with established asthma is inconsistent across studies. This study tested the hypothesis that obese children who have asthma have worse asthma outcomes in comparison with non-obese, non-overweight children with...

Background: Particulate matter air pollution has been associated with adverse health effects. The fraction of ambient particles that are mainly responsible for the observed health effects is still a matter of controversy. Better characterization of the health relevant particle fraction will have major implications for air quality policy since it w...

To evaluate the cost-utility of adding tiotropium to usual care versus usual care alone for patients with moderate to very severe chronic obstructive pulmonary disease (COPD) in the UK and Belgium. A four-state Markov model was developed with three disease severity states (moderate, severe, very severe) and death. Severity was based on post-broncho...

Chronic obstructive pulmonary disease (COPD) is an important global public health challenge because of its high prevalence, morbidity, and mortality. While cigarette smoking has long been seen as the principal risk factor for COPD, recent data suggest that the actual population attributable fraction for smoking is highly variable across different p...

Background: Occupational asthma (OA) remains common; 1 in 10 cases of adult-onset asthma is due to work. Health outcomes are better with early diagnosis, but there is considerable delay, largely due to lack of enquiry about work effect in primary care. National guidelines (2008) recommend asking two screening questions, which together have a high...

The impact of occupational dust and gas/fume exposure on chronic obstructive pulmonary disease (COPD) in developing countries has not been quantified. We examined the relationship between past dust and fume exposure and prevalence of COPD and respiratory symptoms in a cross-sectional analysis of a large Chinese population sample. Participants in th...

Studies of individual inflammatory responses to exposure to air pollution are few but are important in defining the most sensitive markers in better understanding pathophysiological pathways in the lung. The goal of this study was to assess whether exposure to airborne particles is associated with oxidative stress in an epidemiological setting. The...

The readers of the European Respiratory Journal are well aware of the importance of environmental exposures on the incidence and aggravation of several respiratory disorders, including asthma and chronic obstructive pulmonary disease (COPD), leading in some cases to mortality. Almost each month, one or more scientific articles deal with environment...

Epidemiological studies of air pollution on cardiovascular health show associations of cardiac mortality and admissions with exposure to nitrogen dioxide (NO(2)) at low concentrations. These associations could be causal or NO(2) could be acting as a surrogate measure for another air pollutant, most likely ultrafine particles. No studies of cardiac...

It is widely accepted that air pollution can exacerbate asthma in those who already have the condition. What is less clear is whether air pollution can contribute to the initiation of new cases of asthma. Mechanistic evidence from toxicological studies, together with recent information on genes that predispose towards the development of asthma, sug...

The aim of this systematic review was to quantify the impact of biomass fuel and coal use on lung cancer and to explore reasons for heterogeneity in the reported effect sizes. A systematic review of primary studies reporting the relationship between solid fuel use and lung cancer was carried out, based on pre-defined criteria. Studies that dealt wi...

This study aimed to assess the effects of biomass smoke exposure on lung function in a Nepalese population, addressing some of the methodological issues seen in previous studies. We carried out a cross-sectional study of adults in a population exposed to biomass smoke and a non-exposed population in Nepal. Questionnaire and lung function data were...

The evaluation of smoke-free legislation (SFL) in the UK examined the impacts on exposure to second-hand smoke, workers' attitudes and changes in respiratory health. Studies that investigate changes in the health of groups of people often use self-reported symptoms. Due to the subjective nature it is of interest to determine whether workers' attitu...

The European “Year of the Air” 2013 will be upon us soon: over the next several months, the European Union (EU) will revise its main air pollution control policies. Lack of clean air is one of the most important environmental threats to public health in Europe today. The European Respiratory Society Environment and Health Committee (www.ersnet.org)...

Over half the world's population, mostly from developing countries, use solid fuel for domestic purposes and are exposed to very high concentrations of harmful air pollutants with potential health effects such as respiratory problems, cardiovascular problems, infant mortality and ocular problems. The evidence also suggests that, although the total...

Chronic obstructive pulmonary disease (COPD) is an important global public health challenge because of its high prevalence, morbidity, and mortality. While cigarette smoking has long been seen as the principal risk factor for COPD, recent data suggest that the actual population attributable fraction for smoking is highly variable across different p...

The British Thoracic Society (BTS) Standards of Care (SoC) Committee produced a standard of care for occupational asthma (OA) in 2008, based on a systematic evidence review performed in 2004 by the British Occupational Health Research Foundation (BOHRF). BOHRF updated the evidence base from 2004-2009 in 2010. This article summarises the changes in...

Objectives Effects of work on health are well-documented but little is known about those entering the workplace for the first time (when lack of experience is important). We propose an observational study aiming to investigate the pre-employment self-selection of jobs, the lead time for the onset of illnesses, and the immediate effect of work on he...