Air pollution and respiratory symptoms among children with asthma: vulnerability by corticosteroid use and residence area.

RATIONALE Information on how ambient air pollution affects susceptible populations is needed to ensure protective air quality standards. OBJECTIVES To estimate the effect of community-level ambient particulate matter (PM) and ozone (O) on respiratory symptoms among primarily African-American and Latino, lower-income asthmatic children living in Detroit, Michigan and to evaluate factors associated with heterogeneity in observed health effects. METHODS A cohort of 298 children with asthma was studied prospectively from 1999 to 2002. For 14days each season over 11 seasons, children completed a respiratory symptom diary. Simultaneously, ambient pollutant concentrations were measured at two community-level monitoring sites. Logistic regression models using generalized estimating equations were fit for each respiratory symptom in single pollutant models, looking for interactions by area or by corticosteroid use, a marker of more severe asthma. Exposures of interest were: daily concentrations of PM<10μm, <2.5μm, and between 10 and 2.5μm in aerodynamic diameter (PM, PM, and PM respectively), the daily 8-hour maximum concentration of O (8HrPeak), and the daily 1-hour maximum concentration of O (1HrPeak). RESULTS Outdoor PM, PM, 8HrPeak, and 1HrPeak O concentrations were associated with increased odds of respiratory symptoms, particularly among children using corticosteroid medication and among children living in the southwest community of Detroit. Similar patterns of associations were not seen with PM. CONCLUSIONS PM and O at levels near or below annual standard levels are associated with negative health impact in this population of asthmatic children. Variation in effects within the city of Detroit and among the subgroup using steroids emphasizes the importance of spatially refined exposure assessment and the need for further studies to elucidate mechanisms and effective risk reduction interventions.

[1]  A. Tonkin,et al.  Outdoor Air Pollution as a Trigger for Out-of-hospital Cardiac Arrests , 2010, Epidemiology.

[2]  Paolo Montuschi,et al.  Acute Effects of Air Pollution on Pulmonary Function, Airway Inflammation, and Oxidative Stress in Asthmatic Children , 2008, Environmental health perspectives.

[3]  Qinghua Sun,et al.  Contemporary Reviews in Cardiovascular Medicine Cardiovascular Effects of Ambient Particulate Air Pollution Exposure , 2010 .

[4]  Masako Morishita,et al.  Assessment of personal and community-level exposures to particulate matter among children with asthma in Detroit, Michigan, as part of Community Action Against Asthma (CAAA). , 2002, Environmental health perspectives.

[5]  W James Gauderman,et al.  Childhood Asthma and Exposure to Traffic and Nitrogen Dioxide , 2005, Epidemiology.

[6]  Zachary Rowe,et al.  Community-Based Participatory Research: Lessons Learned from the Centers for Children’s Environmental Health and Disease Prevention Research , 2005, Environmental health perspectives.

[7]  Barbara A. Israel,et al.  Personal exposures to particulate matter among children with asthma in Detroit, Michigan , 2004 .

[8]  G. Diette,et al.  Lessons Learned for the Study of Childhood Asthma from the Centers for Children’s Environmental Health and Disease Prevention Research , 2005, Environmental health perspectives.

[9]  D. Dockery,et al.  The effect of air pollution on inner-city children with asthma , 2002, European Respiratory Journal.

[10]  F. Speizer,et al.  Comparison of questionnaire and diary methods in acute childhood respiratory illness surveillance. , 1989, The American review of respiratory disease.

[11]  G. Poirier,et al.  Environmental exposure to polychlorinated biphenyls and placental CYP1A1 activity in Inuit women from northern Québec. , 2002, Environmental health perspectives.

[12]  Ali S. Kamal,et al.  Sources of ambient fine particulate matter at two community sites in Detroit, Michigan , 2008 .

[13]  Francesco Forastiere,et al.  Short-Term Effects of PM10 and NO2 on Respiratory Health among Children with Asthma or Asthma-like Symptoms: A Systematic Review and Meta-Analysis , 2009, Environmental health perspectives.

[14]  B. Israel,et al.  Evaluation of Community Action Against Asthma: A Community Health Worker Intervention to Improve Children's Asthma-Related Health by Reducing Household Environmental Triggers for Asthma , 2008, Health education & behavior : the official publication of the Society for Public Health Education.

[15]  Amy J. Schulz,et al.  Acute Effects of Ambient Particulate Matter on Blood Pressure: Differential Effects Across Urban Communities , 2009, Hypertension.

[16]  F. Dominici,et al.  Fine particulate air pollution and hospital admission for cardiovascular and respiratory diseases. , 2006, JAMA.

[17]  Zachary Rowe,et al.  Community action against asthma , 2003, Journal of General Internal Medicine.

[18]  R. Burnett,et al.  Spatial Analysis of Air Pollution and Mortality in Los Angeles , 2005, Epidemiology.

[19]  Christine E McLaren,et al.  Association of asthma symptoms with peak particulate air pollution and effect modification by anti-inflammatory medication use. , 2002, Environmental health perspectives.

[20]  Rosalind Wright,et al.  Population disparities in asthma. , 2005, Annual review of public health.

[21]  Michael Lipsett,et al.  Air Pollution and Exacerbation of Asthma in African-American Children in Los Angeles , 2001, Epidemiology.

[22]  J. House,et al.  Exposure to fine particulate matter and acute effects on blood pressure: effect modification by measures of obesity and location , 2009, Journal of Epidemiology & Community Health.

[23]  D. Dockery,et al.  The effect of ozone on inner-city children with asthma: identification of susceptible subgroups. , 2000, American journal of respiratory and critical care medicine.

[24]  T. Wong,et al.  Effects of ambient air pollution on lung function growth in Chinese schoolchildren. , 2010, Respiratory medicine.

[25]  T. Holford,et al.  Association of low-level ozone and fine particles with respiratory symptoms in children with asthma. , 2003, JAMA.

[26]  Randall Brown,et al.  Identification of gaps in the diagnosis and treatment of childhood asthma using a community-based participatory research approach , 2004, Journal of Urban Health.

[27]  Amy J. Schulz,et al.  Critical issues in developing and following community based participatory research principles , 2008 .

[28]  Ira B. Tager,et al.  Short-Term Effects of Air Pollution on Wheeze in Asthmatic Children in Fresno, California , 2010, Environmental health perspectives.

[29]  Barbara A. Israel,et al.  Air Pollution–Associated Changes in Lung Function among Asthmatic Children in Detroit , 2005, Environmental health perspectives.

[30]  Francesca Dominici,et al.  Revised Analyses of the National Morbidity, Mortality, and Air Pollution Study: Mortality Among Residents Of 90 Cities , 2005, Journal of toxicology and environmental health. Part A.

[31]  A. Peters,et al.  Particulate Matter Air Pollution and Cardiovascular Disease: An Update to the Scientific Statement From the American Heart Association , 2010, Circulation.

[32]  B. Israel,et al.  Community Involvement in the Conduct of a Health Education Intervention and Research Project: Community Action Against Asthma , 2005, Health promotion practice.

[33]  Anita C. Chalmers,et al.  Symptoms of asthma: Comparison of a parent‐completed retrospective questionnaire with a prospective daily symptom diary , 2003, Pediatric pulmonology.

[34]  K. Berhane,et al.  The effect of air pollution on lung development from 10 to 18 years of age. , 2004, The New England journal of medicine.

[35]  P. Villeneuve,et al.  Acute effects of outdoor air pollution on forced expiratory volume in 1 s: a panel study of schoolchildren with asthma , 2009, European Respiratory Journal.