Effects of Exposure to Incense Smoke Associated with Impaired Lung Function and Respiratory Disease: A Systematic Review

Authors

DOI:

https://doi.org/10.55489/njcm.140520232875

Keywords:

Air quality, Environmental Health, Incense smoke, Inhalation exposure, respiratory disease

Abstract

The community uses incense (bakhour) through ceremonies, traditional health practices, and aromatherapy. Nevertheless, evidence from experiments and studies of populations suggests that a habit of burning incense makes the lungs work less well. The study investigated the relationship between exposure to incense smoke and impaired lung function and respiratory diseases. Data tracing was carried out systematically following PRISMA guidelines from January to April 2022 and registered in the PROSPERO database. The articles selected in this review were cross-sectional, cohort, observational, and experimental studies based on the criteria: (1) animals or humans exposed to incense smoke; (2) exposure to incense smoke which was carried out indoors or outdoors; (3) the selected articles which were included in the original type of article; (4) the publication year between 2016-2021 and the selected articles entered into reputable journals (Scopus and Web of Science). JBI guidelines and synthesis guidelines without meta-analysis (SWiM) to determine the level of evidence and minimize bias and interpretation of results. This study describes respiratory symptoms or diseases, home use of incense, and lung function measurement. Six articles were included; 6 (100%) reported using incense indoors, and 5 (83%) reported using incense outside the home. Respiratory symptoms and diseases caused by exposure to incense sticks are 5 (83%) shortness of breath, 6 (100%) wheezing, asthma, and inflammation of the lungs, 2 (33%) chronic obstructive pulmonary disease, and 4 (67%) allergic rhinitis. Incense smoke particles decrease lung function based on FVC, FEV, PEFR, and FEF values of 25-75%. The results indicate that smoking incense adversely affects lung function and leads to respiratory diseases. The community and related parties can minimize and conduct education and prevention related to simultaneous incense exposure in the community to reduce the burden of diseases and disorders due to respiratory incense smoke in areas that use it daily.

References

Goel A, Wathore R, Chakraborty T, Agrawal M. Characteristics of exposure to particles due to incense burning inside temples in Kanpur, India. Aerosol Air Qual Res. 2017 Feb 1;17(2):608-15. Doi: https://doi.org/10.4209/aaqr.2016.04.0146

Sudaryati NLG, Adnyana IMDM, Suarda IW. Effectiveness of Galuhayu Incense Kluwih Flower (Artocarpus camansi), Pandan Wangi (Pandanus amaryllifolius), Wood Powder as an Insecticide to Minimize Aedes aegypti Mosquito. In: 4th International Conference of Interreligious and Intercultural Studies (ICIIS) Community. Denpasar: UNHI Press; 2020. p. 90-9.

Tsou MCM, Lung SCC, Shen YS, Liu CH, Hsieh YH, Chen N, et al. A community-based study on associations between PM2.5 and PM1 exposure and heart rate variability using wearable low-cost sensing devices. Environmental Pollution. 2021;277:116761. Doi: https://doi.org/10.1016/j.envpol.2021.116761 PMid:33640827

Qin Z, Song Y, Jin Y. Green worship: The effects of devotional and behavioral factors on adopting electronic incense products in reli-gious practices. Int J Environ Res Public Health. 2019;16:3618. Doi: https://doi.org/10.3390/ijerph16193618 PMid:31561617 PMCid:PMC6801997

Lin TC, Krishnaswamy G, Chi DS. Incense smoke: clinical, structural and molecular effects on airway disease. Clinical and Molecular Allergy. 2008 Dec 25;6(1):3. Doi: https://doi.org/10.1186/1476-7961-6-3 PMid:18439280 PMCid:PMC2377255

Mertha Adnyana IMD, Sudiartawan IP, Sudaryati NLG. Toxicity of Tangiayu Incense Smoke as an Insecticide Against Aedes aegypti Mosquito Mortality. Media Ilmu Kesehatan. 2022;10(3):280-9.

Yamamoto N, Kan-o K, Tatsuta M, Ishii Y, Ogawa T, Shinozaki S, et al. Incense smoke-induced oxidative stress disrupts tight junc-tions and bronchial epithelial barrier integrity and induces airway hyperresponsiveness in mouse lungs. Nature. 2021;11:7222. Doi: https://doi.org/10.1038/s41598-021-86745-7 PMid:33790367 PMCid:PMC8012366

Mertha Adnyana IMD, Sudaryati NLG, Sitepu I. Toxicity of Legiayu incense as Insecticide and Larvicide against Aedes aegypti Mos-quitoes Mortality. Indonesian Journal of Pharmacy. 2021;32(4):514-21.

Vardoulakis S, Giagloglou E, Steinle S, Davis A, Sleeuwenhoek A, Galea KS, et al. Indoor exposure to selected air pollutants in the home environment: A systematic review. Int J Environ Res Public Health. 2020;17:8972. Doi: https://doi.org/10.3390/ijerph17238972 PMid:33276576 PMCid:PMC7729884

Manoukian A, Buiron D, Temime-Roussel B, Wortham H, Quivet E. Measurements of VOC/SVOC emission factors from burning in-censes in an environmental test chamber: influence of temperature, relative humidity, and air exchange rate. Environmental Science and Pollution Research. 2016;23(7):6300-11. Doi: https://doi.org/10.1007/s11356-015-5819-2 PMid:26614451

Niu X, Jones T, BéruBé K, Chuang HC, Sun J, Ho KF. The oxidative capacity of indoor source combustion derived particulate matter and resulting respiratory toxicity. Science of the Total Environment. 2021;767:144391. Doi: https://doi.org/10.1016/j.scitotenv.2020.144391 PMid:33429274

Alabdouli A, Alkaabi M, Alao D, Jiaganesh T. "Bakhoored" recurrent carbon monoxide poisoning from burning incense. J Emerg Med. 2020;58(5):848. Doi: https://doi.org/10.1016/j.jemermed.2020.03.051

Lu F, Li S, Shen B, Zhang J, Liu L, Shen X, et al. The emission characteristic of VOCs and the toxicity of BTEX from different mosquito-repellent incenses. J Hazard Mater. 2020 Feb;384:121428. Doi: https://doi.org/10.1016/j.jhazmat.2019.121428 PMid:31699486

Shrestha O. Incense stick: An overlooked source of health hazard. Journal of the Nepal Medical Association. 2020;58(230):823-5. Doi: https://doi.org/10.31729/jnma.5286 PMid:34504363 PMCid:PMC7654492

Mertha Adnyana IMD, Sumarya IM, Sudaryati NLG. Efficacy and Toxicity of Parasayu incense ash as a Larvicide for the Eradication of Aedes aegypti (Diptera: Culicidae) Mosquito Larvae. Journal of Research in Pharmacy. 2022;26(6):1805-13. Doi: https://doi.org/10.29228/jrp.271

Wang J, Zhang Y, Li B, Zhao Z, Huang C, Zhang X, et al. Asthma and allergic rhinitis among young parents in China in relation to out-door air pollution, climate and home environment. Science of the Total Environment. 2021;751(2):141734. Doi: https://doi.org/10.1016/j.scitotenv.2020.141734 PMid:32882555

Cai WH, Wong PPY. Associations between incense-burning temples and respiratory mortality in Hong Kong. Atmosphere (Basel). 2021;12:774. Doi: https://doi.org/10.3390/atmos12060774

Lee CWW, Vo TTT, Wee Y, Chiang YCC, Chi MCC, Chen MLL, et al. The adverse impact of incense smoke on human health: From mech-anisms to implications. J Inflamm Res. 2021;14:5451-72. Doi: https://doi.org/10.2147/JIR.S332771 PMid:34712057 PMCid:PMC8548258

Navasumrit P, Arayasiri M, Hiang OMT, Leechawengwongs M, Promvijit J, Choonvisase S, et al. Potential health effects of exposure to carcinogenic compounds in incense smoke in temple workers. Chem Biol Interact. 2008; Doi: https://doi.org/10.1016/j.cbi.2008.02.004 PMid:18359011

Norbäck D, Lu C, Zhang Y, Li B, Zhao Z, Huang C, et al. Sources of indoor particulate matter (PM) and outdoor air pollution in China in relation to asthma, wheeze, rhinitis and eczema among pre-school children: Synergistic effects between antibiotics use and PM10 and second hand smoke. Environ Int. 2019;125(October 2018):252-60. Doi: https://doi.org/10.1016/j.envint.2019.01.036 PMid:30731375

Tung JC, Huang WC, Yang JC, Chen GY, Fan CC, Chien YC, et al. Auramine O, an incense smoke ingredient, promotes lung cancer malig-nancy. Environ Toxicol [Internet]. 2017;32(11):2379-91. Doi: https://doi.org/10.1002/tox.22451 PMid:28722353 PMCid:PMC5655719

Dalibalta S, Elsayed Y, Alqtaishat F, Gomes I, Fernandes N. A health risk assessment of Arabian incense (Bakhour) smoke in the Unit-ed Arab Emirates. Science of the Total Environment. 2015 Apr 1;511:684-91. Doi: https://doi.org/10.1016/j.scitotenv.2014.12.024 PMid:25602595

Tu CY, Wang BW, Cheng FJ, Chen CH, Hsia TC, Wei YL, et al. Incense burning smoke sensitizes lung cancer cells to EGFR TKI by induc-ing AREG expression. Am J Cancer Res. 2018;8(12):2575-89. Doi: https://doi.org/10.1002/1878-0261.12193 PMid:29570930 PMCid:PMC5928373

Hussain T, Al-Attas OS, Alrokayan SA, Ahmed M, Al-Daghri NM, Al-Ameri S, et al. Deleterious effects of incense smoke exposure on kidney function and architecture in male albino rats. Inhal Toxicol. 2016;28(8):364-73. Doi: https://doi.org/10.1080/08958378.2016.1179372 PMid:27180632

Hussain T, Alamery S, Dikshit G, Mohammed AA, Naushad SM, Alrokayan S. Incense smoke exposure augments systemic oxidative stress, inflammation and endothelial dysfunction in male albino rats. Toxicol Mech Methods. 2019;29(3):211-8. Doi: https://doi.org/10.1080/15376516.2018.1544681 PMid:30480468

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev. 2021 Mar 29;10(1):1-11. Doi: https://doi.org/10.1186/s13643-021-01626-4 PMid:33781348 PMCid:PMC8008539

Campbell M, McKenzie JE, Sowden A, Katikireddi SV, Brennan SE, Ellis S, et al. Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. BMJ. 2020 Jan 16;368:l6890. Doi: https://doi.org/10.1136/bmj.l6890 PMid:31948937 PMCid:PMC7190266

Al Khathlan N, Al-dabbus Z, Al-khdir N, Al-Matar M, Al-Nusaif S, Al Yami B. Incense (bakhour) smoke exposure is associated with respiratory symptoms and impaired lung function among adults: A cross-sectional study in Eastern Province of Saudi Arabia. In-door Air. 2021;31(5):1577-82. Doi: https://doi.org/10.1111/ina.12833 PMid:33826757

Višić B, Kranjc E, Pirker L, Bačnik U, Tavčar G, Škapin S, et al. Incense powder and particle emission characteristics during and after burning incense in an unventilated room setting. Air Qual Atmos Health. 2018 Jul 11;11(6):649-63. Doi: https://doi.org/10.1007/s11869-018-0572-6

Chen YC, Ho WC, Yu YH. Adolescent lung function associated with incense burning and other environmental exposures at home. In-door Air. 2017;27(4):746-52. Doi: https://doi.org/10.1111/ina.12355 PMid:27859699 PMCid:PMC5484285

Rana S. Incense Sticks: A Potential Source of Indoor Air Pollution. International Journal of Environmental Engineering and Manage-ment. 2018;9(1):1-6.

Tran LK, Morawska L, Quang TN, Jayaratne RE, Hue NT, Dat M V., et al. The impact of incense burning on indoor PM2.5 concentra-tions in residential houses in Hanoi, Vietnam. Build Environ. 2021;205:108228. Doi: https://doi.org/10.1016/j.buildenv.2021.108228

Elsayed Y, Dalibalta S, Gomes I, Fernandes N, Alqtaishat F. Chemical composition and potential health risks of raw Arabian incense (Bakhour) Chemical composition and potential health risks of Bakhour. Journal of Saudi Chemical Society. 2016;20(4):465-73. Doi: https://doi.org/10.1016/j.jscs.2014.10.005

Soto-martínez ME. The impact of the enviroment on respiratory outcome. Pediatr Pulmonol. 2017;52(S46):S32-93. Doi: https://doi.org/10.1002/ppul.23729 PMid:28627798 PMCid:PMC7167767

Shaikh R, Bhalekar G. Effect of incense burning exposure on pulmonary functions in temple pandits. International Journal of Scien-tific and Engineering. 2021;12(3):831-40.

Zhang Z, Tan L, Huss A, Guo C, Brook JR, Tse L ah, et al. Household incense burning and children's respiratory health: A cohort study in Hong Kong. Pediatr Pulmonol. 2019;54(4):399-404. Doi: https://doi.org/10.1002/ppul.24251 PMid:30652429

Guo SE, Chi MC, Lin CM, Yang TM. Contributions of burning incense on indoor air pollution levels and on the health status of patients with chronic obstructive pulmonary disease. PeerJ. 2020;8(e9768):1-17. Doi: https://doi.org/10.7717/peerj.9768 PMid:32944420 PMCid:PMC7469933

Jilla A, Kura B. Particulate Matter and Carbon Monoxide Emission Factors from Incense Burning. Environment Pollution and Climate Change. 2017;1(4):1-7. Doi: https://doi.org/10.4172/2573-458X.1000140

Bu-Olayan AH, Thomas B V. Exposition of respiratory ailments from trace metals concentrations in incenses. Nature. 2021;11(1):1-10. Doi: https://doi.org/10.1038/s41598-021-89493-w PMid:34021185 PMCid:PMC8140077

Eljatin DS, Eljatin MRA, Adnyana IMDM, Hutagalung MBZ, Setyawan MF. Excessive Use of Nipah Leaf Membrane Cigarettes Increases the Severity of Spontaneous Pneumothorax: A Case study from Jambi, Indonesia. Journal of Pharmaceutical and Health Research. 2023;4(1):9-13.

Hien TT, Ngo TH, Lung SCC, Ngan TA, Minh TH, Cong-Thanh T, et al. Characterization of Particulate Matter (PM1 and PM2.5) from Incense Burning Activities in Temples in Vietnam and Taiwan. Aerosol Air Qual Res. 2022;22(11):220193. Doi: https://doi.org/10.4209/aaqr.220193

Tran LK, Morawska L, Quang TN, Jayaratne RE, Hue NT, Dat M V., et al. The impact of incense burning on indoor PM2.5 concentra-tions in residential houses in Hanoi, Vietnam. Build Environ. 2021 Nov;205:108228. Doi: https://doi.org/10.1016/j.buildenv.2021.108228

Bootdee S, Chantara S, Prapamontol T. Indoor PM 2.5 and its Polycyclic Aromatic Hydrocarbons in Relation with Incense Burning. IOP Conf Ser Earth Environ Sci. 2018 Mar;120:012007. Doi: https://doi.org/10.1088/1755-1315/120/1/012007

Wei S, Semple S. Exposure to fine particulate matter (PM2.5) from non-tobacco sources in homes within high-income countries: a systematic review. Air Qual Atmos Health. 2023 Mar 28;16(3):553-66. Doi: https://doi.org/10.1007/s11869-022-01288-8 PMid:36467893 PMCid:PMC9703437

P L, L T. Residential incense smoke exposure and obesity among Hong Kong Chinese Elderly. Environmental Epidemiology. 2019 Oct;3:230. Doi: https://doi.org/10.1097/01.EE9.0000608392.17772.80

Liang Z, Zhou L, Infante Cuevas RA, Li X, Cheng C, Li M, et al. Sulfate Formation in Incense Burning Particles: A Single-Particle Mass Spectrometric Study. Environ Sci Technol Lett. 2022 Sep 13;9(9):718-25. Doi: https://doi.org/10.1021/acs.estlett.2c00492

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Published

2023-05-01

How to Cite

1.
Mertha Adnyana IMD, Utomo B, Dewanti L, Fauziyah S, Eljatin DS, Setyawan MF, Sumah LHM, Karina CA. Effects of Exposure to Incense Smoke Associated with Impaired Lung Function and Respiratory Disease: A Systematic Review. Natl J Community Med [Internet]. 2023 May 1 [cited 2024 Apr. 20];14(05):284-93. Available from: https://njcmindia.com/index.php/file/article/view/2875

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Systematic Review/ Meta Analysis