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. 2002 Oct;110(10):A607–A617. doi: 10.1289/ehp.021100607

Association of asthma symptoms with peak particulate air pollution and effect modification by anti-inflammatory medication use.

Ralph J Delfino 1, Robert S Zeiger 1, James M Seltzer 1, Donald H Street 1, Christine E McLaren 1
PMCID: PMC1241047  PMID: 12361942

Abstract

Maxima of hourly data from outdoor monitors may capture adverse effects of outdoor particulate matter (PM) exposures in asthmatic children better than do 24-hr PM averages, which form the basis of current regulations in the United States. Also, asthmatic children on anti-inflammatory medications may be protected against the proinflammatory effects of air pollutants and aeroallergens. We examined strengths of pollutant associations with asthma symptoms between subgroups of asthmatic children who were on versus not on regularly scheduled anti-inflammatory medications, and tested associations for different particle averaging times. This is a daily panel study of 22 asthmatic children (9-19 years of age) followed March through April 1996 (1,248 person-days). They lived in nonsmoking households in a semirural area of Southern California within the air inversion mixing zone (range, 1,200-2,100 feet) with transported air pollution from urban areas of Southern California. The dependent variable derived from diary ordinal scores is episodes of asthma symptoms that interfered with daily activities. Minimum to 90th-percentile levels of exposures at the outdoor monitoring site were 12-63 microg/m(3) for 1-hr PM < 10 microm in aerodynamic diameter (PM(10)); 8-46 microg/m(3) for 8-hr PM(10); 7-32 microg/m(3) for 24-hr PM(10); 45-88 ppb for 1-hr O(3); 6-26 ppb for 8-hr NO(2); 70-4,714 particles/m(3) for 12-hr daytime fungi; and 12-744 particles/m(3) for 24-hr pollen. Data were analyzed with generalized estimating equations controlling for autocorrelation. There was no confounding by weather, day of week, or linear time trend. Associations were notably stronger in 12 asthmatic children who were not taking anti-inflammatory medications versus 10 subjects who were. Odds ratios (95% confidence intervals) for asthma episodes in relation to lag 0 minimum to 90th-percentile pollutant changes were, respectively, 1-hr maximum PM(10), 1.92 (1.22-3.02) versus 0.96 (0.25-3.69); 8-hr maximum PM(10), 1.68 (0.91-3.09) versus 0.75 (0.18-3.04); 24-hr average PM(10), 1.35 (0.82-2.22) versus 0.80 (0.24-2.69); 1-hr maximum O(3), 1.28 (0.75-2.17) versus 0.76 (0.24-2.44); 8-hr maximum NO(2), 1.91 (1.07-3.39) versus 1.08 (0.30-3.93); 12-hr fungi, 1.89 (1.24-2.89) versus 0.90 (0.35-2.30); 24-hr pollen, 1.90 (0.99-3.67) versus 0.85 (0.18-3.91). Pollutant associations were stronger during respiratory infections in subjects not on anti-inflammatory medications. Although lag 0 1-hr maximum PM(10) showed the strongest association, the most robust associations were for lag 0 and 3-day moving averages (lags 0-2) of 8-hr maximum and 24-hr mean PM(10) in sensitivity analyses testing for thresholds. Most pollutant effects were largely driven by concentrations in the upper quintile. The divergence of exposure-response relationships by anti-inflammatory medication use is consistent with experimental data on inflammatory mechanisms of airborne pollutants and allergens.

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Selected References

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  1. Allen G., Sioutas C., Koutrakis P., Reiss R., Lurmann F. W., Roberts P. T. Evaluation of the TEOM method for measurement of ambient particulate mass in urban areas. J Air Waste Manag Assoc. 1997 Jun;47(6):682–689. doi: 10.1080/10473289.1997.10463923. [DOI] [PubMed] [Google Scholar]
  2. Anderson H. R., Ponce de Leon A., Bland J. M., Bower J. S., Emberlin J., Strachan D. P. Air pollution, pollens, and daily admissions for asthma in London 1987-92. Thorax. 1998 Oct;53(10):842–848. doi: 10.1136/thx.53.10.842. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Balmes J. R., Aris R. M., Chen L. L., Scannell C., Tager I. B., Finkbeiner W., Christian D., Kelly T., Hearne P. Q., Ferrando R. Effects of ozone on normal and potentially sensitive human subjects. Part I: Airway inflammation and responsiveness to ozone in normal and asthmatic subjects. Res Rep Health Eff Inst. 1997 Jun;(78):1–99. [PubMed] [Google Scholar]
  4. Blomberg A., Krishna M. T., Helleday R., Söderberg M., Ledin M. C., Kelly F. J., Frew A. J., Holgate S. T., Sandström T. Persistent airway inflammation but accommodated antioxidant and lung function responses after repeated daily exposure to nitrogen dioxide. Am J Respir Crit Care Med. 1999 Feb;159(2):536–543. doi: 10.1164/ajrccm.159.2.9711068. [DOI] [PubMed] [Google Scholar]
  5. Burnett R. T., Smith-Doiron M., Stieb D., Cakmak S., Brook J. R. Effects of particulate and gaseous air pollution on cardiorespiratory hospitalizations. Arch Environ Health. 1999 Mar-Apr;54(2):130–139. doi: 10.1080/00039899909602248. [DOI] [PubMed] [Google Scholar]
  6. Chauhan A. J., Krishna M. T., Frew A. J., Holgate S. T. Exposure to nitrogen dioxide (NO2) and respiratory disease risk. Rev Environ Health. 1998 Jan-Jun;13(1-2):73–90. [PubMed] [Google Scholar]
  7. Delfino R. J., Coate B. D., Zeiger R. S., Seltzer J. M., Street D. H., Koutrakis P. Daily asthma severity in relation to personal ozone exposure and outdoor fungal spores. Am J Respir Crit Care Med. 1996 Sep;154(3 Pt 1):633–641. doi: 10.1164/ajrccm.154.3.8810598. [DOI] [PubMed] [Google Scholar]
  8. Delfino R. J., Zeiger R. S., Seltzer J. M., Street D. H., Matteucci R. M., Anderson P. R., Koutrakis P. The effect of outdoor fungal spore concentrations on daily asthma severity. Environ Health Perspect. 1997 Jun;105(6):622–635. doi: 10.1289/ehp.97105622. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Delfino R. J., Zeiger R. S., Seltzer J. M., Street D. H. Symptoms in pediatric asthmatics and air pollution: differences in effects by symptom severity, anti-inflammatory medication use and particulate averaging time. Environ Health Perspect. 1998 Nov;106(11):751–761. doi: 10.1289/ehp.98106751. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Garty B. Z., Kosman E., Ganor E., Berger V., Garty L., Wietzen T., Waisman Y., Mimouni M., Waisel Y. Emergency room visits of asthmatic children, relation to air pollution, weather, and airborne allergens. Ann Allergy Asthma Immunol. 1998 Dec;81(6):563–570. doi: 10.1016/S1081-1206(10)62707-X. [DOI] [PubMed] [Google Scholar]
  11. Hahon N., Booth J. A., Green F., Lewis T. R. Influenza virus infection in mice after exposure to coal dust and diesel engine emissions. Environ Res. 1985 Jun;37(1):44–60. doi: 10.1016/0013-9351(85)90048-9. [DOI] [PubMed] [Google Scholar]
  12. Hatch G. E., Boykin E., Graham J. A., Lewtas J., Pott F., Loud K., Mumford J. L. Inhalable particles and pulmonary host defense: in vivo and in vitro effects of ambient air and combustion particles. Environ Res. 1985 Feb;36(1):67–80. doi: 10.1016/0013-9351(85)90008-8. [DOI] [PubMed] [Google Scholar]
  13. Health effects of outdoor air pollution. Part 2. Committee of the Environmental and Occupational Health Assembly of the American Thoracic Society. Am J Respir Crit Care Med. 1996 Feb;153(2):477–498. doi: 10.1164/ajrccm.153.2.8564086. [DOI] [PubMed] [Google Scholar]
  14. Jamason P. F., Kalkstein L. S., Gergen P. J. A synoptic evaluation of asthma hospital admissions in New York City. Am J Respir Crit Care Med. 1997 Dec;156(6):1781–1788. doi: 10.1164/ajrccm.156.6.96-05028. [DOI] [PubMed] [Google Scholar]
  15. Jenkins H. S., Devalia J. L., Mister R. L., Bevan A. M., Rusznak C., Davies R. J. The effect of exposure to ozone and nitrogen dioxide on the airway response of atopic asthmatics to inhaled allergen: dose- and time-dependent effects. Am J Respir Crit Care Med. 1999 Jul;160(1):33–39. doi: 10.1164/ajrccm.160.1.9808119. [DOI] [PubMed] [Google Scholar]
  16. Jörres R., Nowak D., Magnussen H. The effect of ozone exposure on allergen responsiveness in subjects with asthma or rhinitis. Am J Respir Crit Care Med. 1996 Jan;153(1):56–64. doi: 10.1164/ajrccm.153.1.8542163. [DOI] [PubMed] [Google Scholar]
  17. Lewis S. A., Corden J. M., Forster G. E., Newlands M. Combined effects of aerobiological pollutants, chemical pollutants and meteorological conditions on asthma admissions and A & E attendances in Derbyshire UK, 1993-96. Clin Exp Allergy. 2000 Dec;30(12):1724–1732. doi: 10.1046/j.1365-2222.2000.00947.x. [DOI] [PubMed] [Google Scholar]
  18. Linaker C. H., Coggon D., Holgate S. T., Clough J., Josephs L., Chauhan A. J., Inskip H. M. Personal exposure to nitrogen dioxide and risk of airflow obstruction in asthmatic children with upper respiratory infection. Thorax. 2000 Nov;55(11):930–933. doi: 10.1136/thorax.55.11.930. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Liu L. J., Delfino R., Koutrakis P. Ozone exposure assessment in a southern California community. Environ Health Perspect. 1997 Jan;105(1):58–65. doi: 10.1289/ehp.9710558. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Liu M. C., Hubbard W. C., Proud D., Stealey B. A., Galli S. J., Kagey-Sobotka A., Bleecker E. R., Lichtenstein L. M. Immediate and late inflammatory responses to ragweed antigen challenge of the peripheral airways in allergic asthmatics. Cellular, mediator, and permeability changes. Am Rev Respir Dis. 1991 Jul;144(1):51–58. doi: 10.1164/ajrccm/144.1.51. [DOI] [PubMed] [Google Scholar]
  21. McConnell R., Berhane K., Gilliland F., London S. J., Vora H., Avol E., Gauderman W. J., Margolis H. G., Lurmann F., Thomas D. C. Air pollution and bronchitic symptoms in Southern California children with asthma. Environ Health Perspect. 1999 Sep;107(9):757–760. doi: 10.1289/ehp.99107757. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Metzger W. J., Zavala D., Richerson H. B., Moseley P., Iwamota P., Monick M., Sjoerdsma K., Hunninghake G. W. Local allergen challenge and bronchoalveolar lavage of allergic asthmatic lungs. Description of the model and local airway inflammation. Am Rev Respir Dis. 1987 Feb;135(2):433–440. doi: 10.1164/arrd.1987.135.2.433. [DOI] [PubMed] [Google Scholar]
  23. Molfino N. A., Wright S. C., Katz I., Tarlo S., Silverman F., McClean P. A., Szalai J. P., Raizenne M., Slutsky A. S., Zamel N. Effect of low concentrations of ozone on inhaled allergen responses in asthmatic subjects. Lancet. 1991 Jul 27;338(8761):199–203. doi: 10.1016/0140-6736(91)90346-q. [DOI] [PubMed] [Google Scholar]
  24. Morgan G., Corbett S., Wlodarczyk J. Air pollution and hospital admissions in Sydney, Australia, 1990 to 1994. Am J Public Health. 1998 Dec;88(12):1761–1766. doi: 10.2105/ajph.88.12.1761. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Mortimer K. M., Tager I. B., Dockery D. W., Neas L. M., Redline S. The effect of ozone on inner-city children with asthma: identification of susceptible subgroups. Am J Respir Crit Care Med. 2000 Nov;162(5):1838–1845. doi: 10.1164/ajrccm.162.5.9908113. [DOI] [PubMed] [Google Scholar]
  26. Nel A. E., Diaz-Sanchez D., Li N. The role of particulate pollutants in pulmonary inflammation and asthma: evidence for the involvement of organic chemicals and oxidative stress. Curr Opin Pulm Med. 2001 Jan;7(1):20–26. doi: 10.1097/00063198-200101000-00004. [DOI] [PubMed] [Google Scholar]
  27. O'Byrne P. M., Dolovich J., Hargreave F. E. Late asthmatic responses. Am Rev Respir Dis. 1987 Sep;136(3):740–751. doi: 10.1164/ajrccm/136.3.740. [DOI] [PubMed] [Google Scholar]
  28. O'byrne P. M., Postma D. S. The many faces of airway inflammation. Asthma and chronic obstructive pulmonary disease. Asthma Research Group. Am J Respir Crit Care Med. 1999 May;159(5 Pt 2):S41–S63. [PubMed] [Google Scholar]
  29. Ostro B., Lipsett M., Mann J., Braxton-Owens H., White M. Air pollution and exacerbation of asthma in African-American children in Los Angeles. Epidemiology. 2001 Mar;12(2):200–208. doi: 10.1097/00001648-200103000-00012. [DOI] [PubMed] [Google Scholar]
  30. Peters A., Dockery D. W., Heinrich J., Wichmann H. E. Medication use modifies the health effects of particulate sulfate air pollution in children with asthma. Environ Health Perspect. 1997 Apr;105(4):430–435. doi: 10.1289/ehp.97105430. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Quackenboss J. J., Krzyzanowski M., Lebowitz M. D. Exposure assessment approaches to evaluate respiratory health effects of particulate matter and nitrogen dioxide. J Expo Anal Environ Epidemiol. 1991 Jan;1(1):83–107. [PubMed] [Google Scholar]
  32. Quintana P. J., Samimi B. S., Kleinman M. T., Liu L. J., Soto K., Warner G. Y., Bufalino C., Valencia J., Francis D., Hovell M. H. Evaluation of a real-time passive personal particle monitor in fixed site residential indoor and ambient measurements. J Expo Anal Environ Epidemiol. 2000 Sep-Oct;10(5):437–445. doi: 10.1038/sj.jea.7500105. [DOI] [PubMed] [Google Scholar]
  33. Roemer W., Clench-Aas J., Englert N., Hoek G., Katsouyanni K., Pekkanen J., Brunekreef B. Inhomogeneity in response to air pollution in European children (PEACE project). Occup Environ Med. 1999 Feb;56(2):86–92. doi: 10.1136/oem.56.2.86. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Rossi G. A., Crimi E., Lantero S., Gianiorio P., Oddera S., Crimi P., Brusasco V. Late-phase asthmatic reaction to inhaled allergen is associated with early recruitment of eosinophils in the airways. Am Rev Respir Dis. 1991 Aug;144(2):379–383. doi: 10.1164/ajrccm/144.2.379. [DOI] [PubMed] [Google Scholar]
  35. Rossi G., Vigotti M. A., Zanobetti A., Repetto F., Gianelle V., Schwartz J. Air pollution and cause-specific mortality in Milan, Italy, 1980-1989. Arch Environ Health. 1999 May-Jun;54(3):158–164. doi: 10.1080/00039899909602254. [DOI] [PubMed] [Google Scholar]
  36. Rossi O. V., Kinnula V. L., Tienari J., Huhti E. Association of severe asthma attacks with weather, pollen, and air pollutants. Thorax. 1993 Mar;48(3):244–248. doi: 10.1136/thx.48.3.244. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Samet J. M., Zeger S. L., Dominici F., Curriero F., Coursac I., Dockery D. W., Schwartz J., Zanobetti A. The National Morbidity, Mortality, and Air Pollution Study. Part II: Morbidity and mortality from air pollution in the United States. Res Rep Health Eff Inst. 2000 Jun;94(Pt 2):5–79. [PubMed] [Google Scholar]
  38. Scannell C., Chen L., Aris R. M., Tager I., Christian D., Ferrando R., Welch B., Kelly T., Balmes J. R. Greater ozone-induced inflammatory responses in subjects with asthma. Am J Respir Crit Care Med. 1996 Jul;154(1):24–29. doi: 10.1164/ajrccm.154.1.8680687. [DOI] [PubMed] [Google Scholar]
  39. Schierhorn K., Zhang M., Matthias C., Kunkel G. Influence of ozone and nitrogen dioxide on histamine and interleukin formation in a human nasal mucosa culture system. Am J Respir Cell Mol Biol. 1999 May;20(5):1013–1019. doi: 10.1165/ajrcmb.20.5.3268. [DOI] [PubMed] [Google Scholar]
  40. Schwartz J., Dockery D. W. Increased mortality in Philadelphia associated with daily air pollution concentrations. Am Rev Respir Dis. 1992 Mar;145(3):600–604. doi: 10.1164/ajrccm/145.3.600. [DOI] [PubMed] [Google Scholar]
  41. Schwartz J., Neas L. M. Fine particles are more strongly associated than coarse particles with acute respiratory health effects in schoolchildren. Epidemiology. 2000 Jan;11(1):6–10. doi: 10.1097/00001648-200001000-00004. [DOI] [PubMed] [Google Scholar]
  42. Schwartz J., Spix C., Wichmann H. E., Malin E. Air pollution and acute respiratory illness in five German communities. Environ Res. 1991 Oct;56(1):1–14. doi: 10.1016/s0013-9351(05)80104-5. [DOI] [PubMed] [Google Scholar]
  43. Schwartz J. Total suspended particulate matter and daily mortality in Cincinnati, Ohio. Environ Health Perspect. 1994 Feb;102(2):186–189. doi: 10.1289/ehp.94102186. [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Spektor D. M., Thurston G. D., Mao J., He D., Hayes C., Lippmann M. Effects of single- and multiday ozone exposures on respiratory function in active normal children. Environ Res. 1991 Aug;55(2):107–122. doi: 10.1016/s0013-9351(05)80167-7. [DOI] [PubMed] [Google Scholar]
  45. Stieb D. M., Beveridge R. C., Brook J. R., Smith-Doiron M., Burnett R. T., Dales R. E., Beaulieu S., Judek S., Mamedov A. Air pollution, aeroallergens and cardiorespiratory emergency department visits in Saint John, Canada. J Expo Anal Environ Epidemiol. 2000 Sep-Oct;10(5):461–477. doi: 10.1038/sj.jea.7500112. [DOI] [PubMed] [Google Scholar]
  46. Strand V., Rak S., Svartengren M., Bylin G. Nitrogen dioxide exposure enhances asthmatic reaction to inhaled allergen in subjects with asthma. Am J Respir Crit Care Med. 1997 Mar;155(3):881–887. doi: 10.1164/ajrccm.155.3.9117021. [DOI] [PubMed] [Google Scholar]
  47. Strand V., Svartengren M., Rak S., Barck C., Bylin G. Repeated exposure to an ambient level of NO2 enhances asthmatic response to a nonsymptomatic allergen dose. Eur Respir J. 1998 Jul;12(1):6–12. doi: 10.1183/09031936.98.12010006. [DOI] [PubMed] [Google Scholar]
  48. Sunyer J., Spix C., Quénel P., Ponce-de-León A., Pönka A., Barumandzadeh T., Touloumi G., Bacharova L., Wojtyniak B., Vonk J. Urban air pollution and emergency admissions for asthma in four European cities: the APHEA Project. Thorax. 1997 Sep;52(9):760–765. doi: 10.1136/thx.52.9.760. [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Tunnicliffe W. S., Burge P. S., Ayres J. G. Effect of domestic concentrations of nitrogen dioxide on airway responses to inhaled allergen in asthmatic patients. Lancet. 1994 Dec 24;344(8939-8940):1733–1736. doi: 10.1016/s0140-6736(94)92886-x. [DOI] [PubMed] [Google Scholar]
  50. Weiss S. T., Ware J. H. Overview of issues in the longitudinal analysis of respiratory data. Am J Respir Crit Care Med. 1996 Dec;154(6 Pt 2):S208–S211. doi: 10.1164/ajrccm/154.6_Pt_2.S208. [DOI] [PubMed] [Google Scholar]
  51. van Eeden S. F., Tan W. C., Suwa T., Mukae H., Terashima T., Fujii T., Qui D., Vincent R., Hogg J. C. Cytokines involved in the systemic inflammatory response induced by exposure to particulate matter air pollutants (PM(10)). Am J Respir Crit Care Med. 2001 Sep 1;164(5):826–830. doi: 10.1164/ajrccm.164.5.2010160. [DOI] [PubMed] [Google Scholar]

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