Practical Indicators for Risk of Airborne Transmission in Shared Indoor Environments and Their Application to COVID-19 Outbreaks.

Some infectious diseases, including COVID-19, can undergo airborne transmission. This may happen at close proximity, but as time indoors increases, infections can occur in shared room air despite distancing. We propose two indicators of infection risk for this situation, that is, relative risk parameter (Hr) and risk parameter (H). They combine the key factors that control airborne disease transmission indoors: virus-containing aerosol generation rate, breathing flow rate, masking and its quality, ventilation and aerosol-removal rates, number of occupants, and duration of exposure. COVID-19 outbreaks show a clear trend that is consistent with airborne infection and enable recommendations to minimize transmission risk. Transmission in typical prepandemic indoor spaces is highly sensitive to mitigation efforts. Previous outbreaks of measles, influenza, and tuberculosis were also assessed. Measles outbreaks occur at much lower risk parameter values than COVID-19, while tuberculosis outbreaks are observed at higher risk parameter values. Because both diseases are accepted as airborne, the fact that COVID-19 is less contagious than measles does not rule out airborne transmission. It is important that future outbreak reports include information on masking, ventilation and aerosol-removal rates, number of occupants, and duration of exposure, to investigate airborne transmission.

The vaccination threshold for SARS-CoV-2 depends on the indoor setting and room ventilation.

BACKGROUND: Effective vaccines are now available for SARS-CoV-2 in the 2nd year of the COVID-19 pandemic, but there remains significant uncertainty surrounding the necessary vaccination rate to safely lift occupancy controls in public buildings and return to pre-pandemic norms. The aim of this paper is to estimate setting-specific vaccination thresholds for SARS-CoV-2 to prevent sustained community transmission using classical principles of airborne contagion modeling. We calculated the airborne infection risk in three settings, a classroom, prison cell block, and restaurant, at typical ventilation rates, and then the expected number of infections resulting from this risk at varying percentages of occupant immunity. RESULTS: We estimate the setting-specific immunity threshold for control of wild-type SARS-CoV-2 to range from a low of 40% for a mechanically ventilation classroom to a high of 85% for a naturally ventilated restaurant. CONCLUSIONS: If vaccination rates are limited to a theoretical minimum of approximately two-thirds of the population, enhanced ventilation above minimum standards for acceptable air quality is needed to reduce the frequency and severity of SARS-CoV-2 superspreading events in high-risk indoor environments.

Ventilation procedures to minimize the airborne transmission of viruses in classrooms.

Reducing the transmission of SARS-CoV-2 through indoor air is the key challenge of the COVID-19 pandemic. Crowded indoor environments, such as schools, represent possible hotspots for virus transmission since the basic non-pharmaceutical mitigation measures applied so far (e.g. social distancing) do not eliminate the airborne transmission mode. There is widespread consensus that improved ventilation is needed to minimize the transmission potential of airborne viruses in schools, whether through mechanical systems or ad-hoc manual airing procedures in naturally ventilated buildings. However, there remains significant uncertainty surrounding exactly what ventilation rates are required, and how to best achieve these targets with limited time and resources. This paper uses a mass balance approach to quantify the ability of both mechanical ventilation and ad-hoc airing procedures to mitigate airborne transmission risk in the classroom environment. For naturally-ventilated classrooms, we propose a novel feedback control strategy using CO2 concentrations to continuously monitor and adjust the airing procedure. Our case studies show how such procedures can be applied in the real world to support the reopening of schools during the pandemic. Our results also show the inadequacy of relying on absolute CO2 concentration thresholds as the sole indicator of airborne transmission risk.

A pilot study of traditional indoor biomass cooking and heating in rural Bhutan: gas and particle concentrations and emission rates.

Although many studies have reported the health effects of biomass fuels in developing countries, relatively few have quantitatively characterized emissions from biomass stoves during cooking and heating. The aim of this pilot study was to characterize the emission characteristics of different biomass stoves in four rural houses in Bhutan during heating (metal chimney stove), rice cooking (traditional mud stove), fodder preparation (stone tripod stove), and liquor distillation (traditional mud stove). Three stage measurements (before, during, and after the activity had ceased) were conducted for PM2.5 , particle number (PN), CO, and CO2 . When stoves were operated, the pollutant concentrations were significantly elevated above background levels, by an average of 40 and 18 times for PM2.5 and CO, respectively. Emission rates (mg/min) ranged from 1.07 × 102 (PM2.5 ) and 3.50 × 102 (CO) for the stone tripod stove during fodder preparation to 6.20 × 102 (PM2.5 ) and 2.22 × 103 (CO) for the traditional mud stove during liquor distillation. Usable PN data were only available for one house, during heating using a metal chimney stove, which presented an emission rate of 3.24 × 1013 particles/min. Interventions to control household air pollution in Bhutan, in order to reduce the health risks associated with cooking and heating, are recommended.

Sources and dynamics of fluorescent particles in hospitals.

Fluorescent particles can be markers of bioaerosols and are therefore relevant to nosocomial infections. To date, little research has focused on fluorescent particles in occupied indoor environments, particularly hospitals. In this study, we aimed to determine the spatial and temporal variation of fluorescent particles in two large hospitals in Brisbane, Australia (one for adults and one for children). We used an Ultraviolet Aerodynamic Particle Sizer (UVAPS) to identify fluorescent particle sources, as well as their contribution to total particle concentrations. We found that the average concentrations of both fluorescent and non-fluorescent particles were higher in the adults' hospital (0.06×106 and 1.20×106  particles/m3 , respectively) than in the children's hospital (0.03×106 and 0.33×106  particles/m3 , respectively) (P<.01). However, the proportion of fluorescent particles was higher in the children's hospital. Based on the concentration results and using activity diaries, we were able to identify sources of particle production within the two hospitals. We demonstrated that particles can be easily generated by a variety of everyday activities, which are potential sources of exposure to pathogens. Future studies to further investigate their role in nosocomial infection are warranted.

Unexpected increase in indoor pollutants after the introduction of a smoke-free policy in a correctional center.

Correctional centers (prisons) are one of the few non-residential indoor environments where smoking is still permitted. However, few studies have investigated indoor air quality (IAQ) in these locations. We quantified the level of inmate and staff exposure to secondhand smoke, including particle number (PN) count, and we assessed the impact of the smoking ban on IAQ. We performed measurements of indoor and outdoor PM2.5 and PN concentrations, personal PN exposure levels, volatile organic compounds (VOCs), and nicotine both before and after a complete indoor smoking ban in an Australian maximum security prison. Results show that the indoor 24-h average PM2.5 concentrations ranged from 6 (±1) µg/m(3) to 17 (±3) µg/m(3) pre-ban. The post-ban levels ranged from 7 (±2) µg/m(3) to 71 (±43) µg/m(3) . While PM2.5 concentrations decreased in one unit post-ban, they increased in the other two units. Similar post-ban increases were also observed in levels of PN and VOCs. We describe an unexpected increase of indoor pollutants following a total indoor smoking ban in a prison that was reflected across multiple pollutants that are markers of smoking. We hypothesise that clandestine post-ban smoking among inmates may have been the predominant cause.

Atmospheric Visibility and PM10 as Indicators of New Particle Formation in an Urban Environment.

It is well-known that new particle formation (NPF) in the atmosphere is inhibited by pre-existing particles in the air that act as condensation sinks to decrease the concentration and, thus, the supersaturation of precursor gases. In this study, we investigate the effects of two parameters-atmospheric visibility, expressed as the particle backscatter coefficient (BSP), and PM10 particulate mass concentration-on the occurrences of NPF events in an urban environment where the majority of precursor gases originate from motor vehicle and industrial sources. This is the first attempt to derive direct relationships between these two parameters and the occurrence of NPF. NPF events were identified from data obtained with a neutral cluster and air ion spectrometer over 245 days within a calendar year. Bayesian logistic regression was used to determine the probability of observing NPF as functions of BSP and PM10. We show that the BSP at 08 h on a given day is a reliable indicator of an NPF event later that day. The posterior median probability of observing an NPF event was greater than 0.5 (95%) when the BSP at 08 h was less than 6.8 Mm(-1).

Lung cancer risk of airborne particles for Italian population.

Airborne particles, including both ultrafine and supermicrometric particles, contain various carcinogens. Exposure and risk-assessment studies regularly use particle mass concentration as dosimetry parameter, therefore neglecting the potential impact of ultrafine particles due to their negligible mass compared to supermicrometric particles. The main purpose of this study was the characterization of lung cancer risk due to exposure to polycyclic aromatic hydrocarbons and some heavy metals associated with particle inhalation by Italian non-smoking people. A risk-assessment scheme, modified from an existing risk model, was applied to estimate the cancer risk contribution from both ultrafine and supermicrometric particles. Exposure assessment was carried out on the basis of particle number distributions measured in 25 smoke-free microenvironments in Italy. The predicted lung cancer risk was then compared to the cancer incidence rate in Italy to assess the number of lung cancer cases attributed to airborne particle inhalation, which represents one of the main causes of lung cancer, apart from smoking. Ultrafine particles are associated with a much higher risk than supermicrometric particles, and the modified risk-assessment scheme provided a more accurate estimate than the conventional scheme. Great attention has to be paid to indoor microenvironments and, in particular, to cooking and eating times, which represent the major contributors to lung cancer incidence in the Italian population. The modified risk assessment scheme can serve as a tool for assessing environmental quality, as well as setting up exposure standards for particulate matter.

Environmental contamination and hospital-acquired infection: factors that are easily overlooked.

There is an ongoing debate about the reasons for and factors contributing to healthcare-associated infection (HAI). Different solutions have been proposed over time to control the spread of HAI, with more focus on hand hygiene than on other aspects such as preventing the aerial dissemination of bacteria. Yet, it emerges that there is a need for a more pluralistic approach to infection control; one that reflects the complexity of the systems associated with HAI and involves multidisciplinary teams including hospital doctors, infection control nurses, microbiologists, architects, and engineers with expertise in building design and facilities management. This study reviews the knowledge base on the role that environmental contamination plays in the transmission of HAI, with the aim of raising awareness regarding infection control issues that are frequently overlooked. From the discussion presented in the study, it is clear that many unknowns persist regarding aerial dissemination of bacteria, and its control via cleaning and disinfection of the clinical environment. There is a paucity of good-quality epidemiological data, making it difficult for healthcare authorities to develop evidence-based policies. Consequently, there is a strong need for carefully designed studies to determine the impact of environmental contamination on the spread of HAI.

The hospitalisation risk of chronic circulatory and respiratory diseases associated with coal mining in the general population in Queensland, Australia.

Queensland is the main coal mining state in Australia where populations in coal mining areas have been historically exposed to coal mining emissions. Although a higher risk of chronic circulatory and respiratory diseases has been associated with coal mining globally, few studies have investigated these associations in the Queensland general population. This study estimates the association of coal production with hospitalisations for chronic circulatory and respiratory diseases in Queensland considering spatial and temporal variations during 1997-2014. An ecological analysis used a Bayesian hierarchical spatiotemporal model to estimate the association of coal production with standardised rates of each, chronic circulatory and respiratory diseases, adjusting for sociodemographic factors and considering the spatial structure of Queensland's statistical areas (SA2) in the 18-year period. Two specifications; with and without a space-time interaction effect were compared using the integrated nested Laplace approximation -INLA approach. The posterior mean of the best fit model was used to map the spatial, temporal and spatiotemporal trends of risk. The analysis considered 2,831,121 hospitalisation records. Coal mining was associated with a 4 % (2.4-5.5) higher risk of hospitalisation for chronic respiratory diseases in the model with a space-time interaction effect which had the best fit. An emerging higher risk of either chronic circulatory and respiratory diseases was identified in eastern areas and some coal-mining areas in central and southeast Queensland. There were important disparities in the spatiotemporal trend of risk between coal -and non-coal mining areas for each, chronic circulatory and respiratory diseases. Coal mining is associated with an increased risk of chronic respiratory diseases in the Queensland general population. Bayesian spatiotemporal analyses are robust methods to identify environmental determinants of morbidity in exposed populations. This methodology helps identifying at-risk populations which can be useful to support decision-making in health. Future research is required to investigate the causality links between coal mining and these diseases.

Review of scientific research on air quality and environmental health risk and impact for PICTS.

Air quality (AQ) significantly impacts human health, influenced by both natural phenomena and human activities. In 2021, heightened awareness of AQ's health impacts prompted the revision of the World Health Organization (WHO) guidelines, advocating for stricter pollution standards. However, research on AQ has predominantly focused on high-income countries and densely populated cities, neglecting low- and middle-income countries, particularly Pacific Island Countries, Territories, and States (PICTS). This systematic review compiles existing peer-reviewed literature on AQ research in PICTS to assess the current state of knowledge and emphasize the need for further investigation. A systematic literature search yielded 40 papers from databases including Web of Science, Scopus, and Embase. Among the 26 PICTS, only 6 (Hawai'i, Fiji, Papua New Guinea, New Caledonia, Republic of Marshall Islands, and Pacific) have been subject to AQ-related research, with 4 considering the World Health Organization (WHO) parameters and 26 addressing non-WHO parameters. Analysis reveals AQ parameters often exceed 2021 WHO guidelines for PM2.5, PM10, SO2, and CO, raising concerns among regional governments. Studies primarily focused on urban, agricultural, rural, and open ocean areas, with 15 based on primary data and 14 on both primary and secondary sources. Research interests and funding sources dictated the methods used, with a predominant focus on environmental risks over social, economic, and technological impacts. Although some papers addressed health implications, further efforts are needed in this area. This review underscores the urgent need for ongoing AQ monitoring efforts in PICTS to generate spatially and temporally comparable data. By presenting the current state of AQ knowledge, this work lays the foundation for coordinated regional monitoring and informs national policy development.

Indoor aerosols: from personal exposure to risk assessment.

Motivated by growing considerations of the scale, severity, and risks associated with human exposure to indoor particulate matter, this work reviewed existing literature to: (i) identify state-of-the-art experimental techniques used for personal exposure assessment; (ii) compare exposure levels reported for domestic/school settings in different countries (excluding exposure to environmental tobacco smoke and particulate matter from biomass cooking in developing countries); (iii) assess the contribution of outdoor background vs indoor sources to personal exposure; and (iv) examine scientific understanding of the risks posed by personal exposure to indoor aerosols. Limited studies assessing integrated daily residential exposure to just one particle size fraction, ultrafine particles, show that the contribution of indoor sources ranged from 19% to 76%. This indicates a strong dependence on resident activities, source events and site specificity, and highlights the importance of indoor sources for total personal exposure. Further, it was assessed that 10-30% of the total burden of disease from particulate matter exposure was due to indoor-generated particles, signifying that indoor environments are likely to be a dominant environmental factor affecting human health. However, due to challenges associated with conducting epidemiological assessments, the role of indoor-generated particles has not been fully acknowledged, and improved exposure/risk assessment methods are still needed, together with a serious focus on exposure control.

The risk of airborne influenza transmission in passenger cars.

Travel in passenger cars is a ubiquitous aspect of the daily activities of many people. During the 2009 influenza A(H1N1) pandemic a case of probable transmission during car travel was reported in Australia, to which spread via the airborne route may have contributed. However, there are no data to indicate the likely risks of such events, and how they may vary and be mitigated. To address this knowledge gap, we estimated the risk of airborne influenza transmission in two cars (1989 model and 2005 model) by employing ventilation measurements and a variation of the Wells-Riley model. Results suggested that infection risk can be reduced by not recirculating air; however, estimated risk ranged from 59% to 99·9% for a 90-min trip when air was recirculated in the newer vehicle. These results have implications for interrupting in-car transmission of other illnesses spread by the airborne route.

Volatile properties of particles emitted by compressed natural gas and diesel buses during steady-state and transient driving modes.

Volatile properties of particle emissions from four compressed natural gas (CNG) and four diesel buses were investigated under steady-state and transient driving modes on a chassis dynamometer. The exhaust was diluted utilizing a full-flow continuous volume sampling system and passed through a thermodenuder at controlled temperature. Particle number concentration and size distribution were measured with a condensation particle counter and a scanning mobility particle sizer, respectively. We show that while almost all the particles emitted by the CNG buses were in the nanoparticle size range, at least 85% and 98% were removed at 100 and 250 °C, respectively. Closer analysis of the volatility of particles emitted during transient cycles showed that volatilization began at around 40 °C, with the majority occurring by 80 °C. Particles produced during hard acceleration from rest exhibited lower volatility than those produced during other times of the cycle. On the basis of our results and the observation of ash deposits on the walls of the tailpipes, we suggest that these nonvolatile particles were composed mostly of ash from lubricating oil. Heating the diesel bus emissions to 100 °C removed ultrafine particle numbers by 69-82% when a nucleation mode was present and just 18% when it was not.

Assessment of SARS-CoV-2 airborne infection transmission risk in public buses.

Public transport environments are thought to play a key role in the spread of SARS-CoV-2 worldwide. Indeed, high crowding indexes (i.e. high numbers of people relative to the vehicle size), inadequate clean air supply, and frequent extended exposure durations make transport environments potential hotspots for transmission of respiratory infections. During the COVID-19 pandemic, generic mitigation measures (e.g. physical distancing) have been applied without also considering the airborne transmission route. This is due to the lack of quantified data about airborne contagion risk in transport environments. In this study, we apply a novel combination of close proximity and room-scale risk assessment approaches for people sharing public transport environments to predict their contagion risk due to SARS-CoV-2 respiratory infection. In particular, the individual infection risk of susceptible subjects and the transmissibility of SARS-CoV-2 (expressed through the reproduction number) are evaluated for two types of buses, differing in terms of exposure time and crowding index: urban and long-distance buses. Infection risk and reproduction number are calculated for different scenarios as a function of the ventilation rates (both measured and estimated according to standards), crowding indexes, and travel times. The results show that for urban buses, the close proximity contribution significantly affects the maximum occupancy to maintain a reproductive number of <1. In particular, full occupancy of the bus would be permitted only for an infected subject breathing, whereas for an infected subject speaking, masking would be required. For long-distance buses, full occupancy of the bus can be maintained only if specific mitigation solutions are simultaneously applied. For example, for an infected person speaking for 1 h, appropriate filtration of the recirculated air and simultaneous use of FFP2 masks would permit full occupancy of the bus for a period of almost 8 h. Otherwise, a high percentage of immunized persons (>80%) would be needed.

Link between SARS-CoV-2 emissions and airborne concentrations: Closing the gap in understanding.

The airborne transmission of SARS-CoV-2 remains surprisingly controversial; indeed, health and regulatory authorities still require direct proof of this mode of transmission. To close this gap, we measured the viral load of SARS-CoV-2 of an infected subject in a hospital room (through an oral and nasopharyngeal swab), as well as the airborne SARS-CoV-2 concentration in the room resulting from the person breathing and speaking. Moreover, we simulated the same scenarios to estimate the concentration of RNA copies in the air through a novel theoretical approach and conducted a comparative analysis between experimental and theoretical results. Results showed that for an infected subject's viral load ranging between 2.4 × 106 and 5.5 × 106 RNA copies mL-1, the corresponding airborne SARS-CoV-2 concentration was below the minimum detection threshold when the person was breathing, and 16.1 (expanded uncertainty of 32.8) RNA copies m-3 when speaking. The application of the predictive approach provided concentrations metrologically compatible with the available experimental data (i.e. for speaking activity). Thus, the study presented significant evidence to close the gap in understanding airborne transmission, given that the airborne SARS-CoV-2 concentration was shown to be directly related to the SARS-CoV-2 emitted. Moreover, the theoretical analysis was shown to be able to quantitatively link the airborne concentration to the emission.

Influence of indoor airflow on particle spread of a single breath and cough in enclosures: Does opening a window really 'help'?

The spread of respiratory diseases via aerosol particles in indoor settings is of significant concern. The SARS-CoV-2 virus has been found to spread widely in confined enclosures like hotels, hospitals, cruise ships, prisons, and churches. Particles exhaled from a person indoors can remain suspended long enough for increasing the opportunity for particles to spread spatially. Careful consideration of the ventilation system is essential to minimise the spread of particles containing infectious pathogens. Previous studies have shown that indoor airflow induced by opened windows would minimise the spread of particles. However, how outdoor airflow through an open window influences the indoor airflow has not been considered. The aim of this study is to provide a clear understanding of the indoor particle spread across multiple rooms, in a situation similar to what is found in quarantine hotels and cruise ships, using a combination of HVAC (Heating, Ventilation and Air-Conditioning) ventilation and an opening window. Using a previously validated mathematical model, we used 3D CFD (computational fluid dynamics) simulations to investigate to what extent different indoor airflow scenarios contribute to the transport of a single injection of particles ( 1 . 3 µ m ) in a basic 3D multi-room indoor environment. Although this study is limited to short times, we demonstrate that in certain conditions approximately 80% of the particles move from one room to the corridor and over 60% move to the nearby room within 5 to 15 s. Our results provide additional information to help identifying relevant recommendations to limit particles from spreading in enclosures.

Role of vegetation in enhancing radon concentration and ion production in the atmosphere.

The role of ions in the production of atmospheric particles has gained wide interest due to their profound impact on climate. Away from anthropogenic sources, molecules are ionized by alpha radiation from radon exhaled from the ground and cosmic γ radiation from space. These molecular ions quickly form into "cluster ions", typically smaller than about 1.5 nm. Using our measurements and the published literature, we present evidence to show that cluster ion concentrations in forest areas are consistently higher than outside. Owing to the low range of alpha particles, radon present deep in the ground cannot directly contribute to the measured cluster ion concentrations. We propose an additional mechanism whereby radon, which is water-soluble, is brought up by trees and plants through the uptake of groundwater and released into the atmosphere by transpiration. We estimate that, in a forest comprising eucalyptus trees spaced 4 m apart, trees may account for up to 37% of the radon that is released from the ground during the middle of the day when transpiration rates are high. The corresponding percentage on an annual basis is 4.1%. Considering that 24% of the earth's land area is still covered in forests; these findings have potentially important implications for atmospheric aerosol formation and climate.

Pollutant concentrations within households in Lao PDR and association with housing characteristics and occupants' activities.

The paper presents the results of a study conducted to investigate indoor air quality within residential dwellings in Lao PDR. Results from PM(10), CO, and NO(2) measurements inside 167 dwellings in Lao PDR over a five month period (December 2005-April 2006) are discussed as a function of household characteristics and occupant activities. Extremely high PM(10) and NO(2) concentrations (12 h mean PM(10) concentrations 1275 ± 98 µg m(-3) and 1183 ± 99 µg m(-3) in Vientiane and Bolikhamxay provinces, respectively; 12 h mean NO(2) concentrations 1210 ± 94 µg m(-3) and 561 ± 45 µg m(-3) in Vientiane and Bolikhamxay, respectively) were measured within the dwellings. Correlations, ANOVA analysis (univariate and multivariate), and linear regression results suggest a substantial contribution from cooking and smoking. The PM(10) concentrations were significantly higher in houses without a chimney compared to houses in which cooking occurred on a stove with a chimney. However, no significant differences in pollutant concentrations were observed as a function of cooking location. Furthermore, PM(10) and NO(2) concentrations were higher in houses in which smoking occurred, suggestive of a relationship between increased indoor concentrations and smoking (0.05 < p < 0.10). Resuspension of dust from soil floors was another significant source of PM(10) inside the house (634 µg m(-3), p < 0.05).

Association between indoor air pollution measurements and respiratory health in women and children in Lao PDR.

UNLABELLED: This article presents the results of a study on the association between measured air pollutants and the respiratory health of resident women and children in Lao PDR, one of the least developed countries in Southeast Asia. The study, commissioned by the World Health Organisation, included PM(10), CO and NO(2) measurements made inside 181 dwellings in nine districts within two provinces in Lao PDR over a 5-month period (12/05-04/06), and respiratory health information (via questionnaires and peak expiratory flow rate (PEFR) measurements) for all residents in the same dwellings. Adjusted odds ratios were calculated separately for each health outcome using binary logistic regression. There was a strong and consistent positive association between NO(2) and CO for almost all questionnaire-based health outcomes for both women and children. Women in dwellings with higher measured NO(2) had more than triple of the odds of almost all of the health outcomes, and higher concentrations of NO(2) and CO were significantly associated with lower PEFR. This study supports a growing literature confirming the role of indoor air pollution in the burden of respiratory disease in developing countries. The results will directly support changes in health and housing policy in Lao PDR. PRACTICAL IMPLICATIONS: This is the first study that investigated indoor air quality and its impact within residential dwellings in Lao PDR, which is one of the poorest and least developed countries in south-east Asia, with a life-expectancy of 56 years in 2008. While there have been other studies published on indoor air quality in other developing countries, the situation in Laos is different because the majority of houses in Laos used wood stoves, and therefore, emissions from wood burning are the dominant sources of indoor air pollution. In other countries, and studies, while emission from wood burning was investigated, wood was rarely the main or the only fuel used, as the houses used in addition (or solely) dung, kerosene or coal. The study quantified, for the first time, concentrations in houses two provinces in Laos PDR and shed light on the impact of human activities and urban design on pollutant concentrations and respiratory health. This study contributes to the accumulation of evidence to provide more reliable estimates of risk and a more informed basis for decision-making by concerned governments and communities.