Thorax 65:528-533 doi:10.1136/thx.2009.119347
  • Environmental exposure

A prospective study of respiratory symptoms associated with chronic arsenic exposure in Bangladesh: findings from the Health Effects of Arsenic Longitudinal Study (HEALS)

  1. Habibul Ahsan4
  1. 1Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, USA
  2. 2Department of Environmental Medicine, New York University School of Medicine, New York, USA
  3. 3Columbia University/University of Chicago Arsenic Research Office in Bangladesh, Dhaka, Bangladesh
  4. 4Department of Health Studies and Cancer Research Center, University of Chicago, Chicago, USA
  1. Correspondence to Habibul Ahsan, Department of Health Studies and Comprehensive Cancer Center, University of Chicago, Chicago, USA; habib{at}
  • Received 7 May 2009
  • Accepted 28 March 2010


Background and aims A prospective cohort study was conducted to evaluate the effect of arsenic (As) exposure from drinking water on respiratory symptoms using data from the Health Effects of Arsenic Exposure Longitudinal Study (HEALS), a large prospective cohort study established in Ariahazar, Bangladesh in 2000–2002. A total of 7.31, 9.95 and 2.03% of the 11 746 participants completing 4 years of active follow-up reported having a chronic cough, breathing problem or blood in their sputum, respectively, as assessed by trained physicians.

Methods Cox regression models were used to estimate HRs for respiratory symptoms during the follow-up period in relation to levels of chronic As exposure assessed at baseline, adjusting for age, gender, smoking, body mass index, education and arsenic-related skin lesion status.

Results Significant positive associations were found between As exposure and respiratory symptoms. As compared with those with the lowest quintile of water As level (≤7 μg/l), the HRs for having respiratory symptoms were 1.27 (95% CI 1.09 to 1.48), 1.39 (95% CI 1.19 to 1.63), 1.43 (95% CI 1.23 to 1.68) and 1.43 (95% CI 1.22 to 1.68) for the second to fifth quintiles of baseline water As concentrations (7–40, 40–90, 90–178 and >178 μg/l), respectively. Similarly, the corresponding HRs in relation to the second to fifth quintiles of urinary arsenic were 1.10 (95% CI 0.94 to 1.27), 1.11 (95% CI 0.95 to 1.29), 1.29 (95% CI 1.11 to 1.49) and 1.35 (95% CI 1.16 to 1.56), respectively. These associations did not differ appreciably by cigarette smoking status.

Conclusions This prospective cohort study found a dose–response relationship between As exposure and clinical symptoms of respiratory diseases in Bangladesh. In particular, these adverse respiratory effects of As were clearly evident in the low to moderate dose range, suggesting that a large proportion of the country's population may be at risk of developing serious lung diseases in the future.


  • Funding This research was supported by US National Institutes of Health Grants P42 ES10349, P30 ES09089, R01 CA107431 and R01 CA102484.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Institutional Review Boards of Columbia University, University of Chicago and the Bangladesh Medical Research Council.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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