Current Environmental Health Reports

, Volume 5, Issue 2, pp 244–254 | Cite as

A Meta-analysis of Arsenic Exposure and Lung Function: Is There Evidence of Restrictive or Obstructive Lung Disease?

  • Tiffany R. SanchezEmail author
  • Martha Powers
  • Matthew Perzanowski
  • Christine M. George
  • Joseph H. Graziano
  • Ana Navas-Acien
Water and Health (T Wade, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Water and Health


Purpose of Review

Hundreds of millions of people worldwide are exposed to arsenic via contaminated water. The goal of this study was to identify whether arsenic-associated lung function deficits resemble obstructive- or restrictive-like lung disease, in order to help illuminate a mechanistic pathway and identify at-risk populations.

Recent Findings

We recently published a qualitative systematic review outlining the body of research on arsenic and non-malignant respiratory outcomes. Evidence from several populations, at different life stages, and at different levels of exposure showed consistent associations of arsenic exposure with chronic lung disease mortality, respiratory symptoms, and lower lung function levels. The published review, however, only conducted a broad qualitative description of the published studies without considering specific spirometry patterns, without conducting a meta-analysis, and without evaluating the dose-response relationship.


We searched PubMed and Embase for studies on environmental arsenic exposure and lung function. We performed a meta-analysis using inverse-variance-weighted random effects models to summarize adjusted effect estimates for arsenic and forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio. Across nine studies, median water arsenic levels ranged from 23 to 860 μg/L. The pooled estimated mean difference (MD) comparing the highest category of arsenic exposure (ranging from > 11 to > 800 μg/L) versus the lowest (ranging from < 10 to < 100 μg/L) for each study for FEV1 was – 42 mL (95% confidence interval (CI) − 70, − 16) and for FVC was – 50 mL (95% CI − 63, − 37). Three studies reported effect estimates for FEV1/FVC, for which there was no evidence of an association; the pooled estimated MD was 0.01 (95% CI − 0.005, 0.024). This review supports that arsenic is associated with restrictive impairments based on inverse associations between arsenic and FEV1 and FVC, but not with FEV1/FVC. Future studies should confirm whether low-level arsenic exposure is a restrictive lung disease risk factor in order to identify at-risk populations in the USA.


Arsenic Epidemiology Meta-analysis Restrictive lung disease Spirometry Systematic review 



American Thoracic Society


Cystic fibrosis transmembrane conductance


European Respiratory Society


Ratio of FEV1 to FVC


Forced expiratory volume in one second


Forced vital capacity


Pulmonary function test


Funding Information

This work was supported by the National Institute of Environmental Health Sciences at the National Institutes of Health (grant numbers R01ES021367, 1R01ES025216, 5P30ES009089, and P42ES010349).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Supplementary material

40572_2018_192_MOESM1_ESM.docx (251 kb)
ESM 1 (DOCX 250 kb)


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Tiffany R. Sanchez
    • 1
    Email author
  • Martha Powers
    • 2
  • Matthew Perzanowski
    • 1
  • Christine M. George
    • 3
  • Joseph H. Graziano
    • 1
  • Ana Navas-Acien
    • 1
  1. 1.Department of Environmental Health SciencesColumbia UniversityNew YorkUSA
  2. 2.Department of Environmental Health and EngineeringJohns Hopkins University Bloomberg School of Public HealthBaltimoreUSA
  3. 3.Department of International HealthJohns Hopkins University Bloomberg School of Public HealthBaltimoreUSA

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