Ambient air pollution, lung function, and airway responsiveness in asthmatic children

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• 作者：Despo Ierodiakonou ; MD ; PhD^a ; ^b ; ^{d.ierodiakonou@euc.ac.cy" class="auth_mail" title="E-mail the corresponding author} ; Antonella Zanobetti ; PhD^c ; Brent A. Coull ; PhD^d ; Steve Melly ; MS^c ; Dirkje S. Postma ; MD ; PhD^b ; ^e ; H. Marike Boezen ; PhD^a ; ^b ; Judith M. Vonk ; PhD^a ; ^b ; Paul V. Williams ; MD^f ; Gail G. Shapiro ; MD^f ; ^&dagger ; ; Edward F. McKone ; MD ; MS^g ; Teal S. Hallstrand ; MD ; MPH^h ; Jane Q. Koenig ; PhDⁱ ; Jonathan S. Schildcrout ; PhD^j ; Thomas Lumley ; PhD^k ; Anne N. Fuhlbrigge ; MD ; MS^l ; Petros Koutrakis ; PhD^c ; Joel Schwartz ; PhD^c ; Scott T. Weiss ; MD ; PhD^l ; Diane R. Gold ; MD ; MPH^c ; ^l ; ^{diane.gold@channing.harvard.edu" class="auth_mail" title="E-mail the corresponding author} ; for the Childhood Asthma Management Program Research Group
• 关键词：Asthma ; ambient air pollution ; airway hyperresponsiveness ; inhaled corticosteroids ; lung function
• 刊名：Journal of Allergy and Clinical Immunology
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：137
• 期：2
• 页码：390-399
• 全文大小：445 K

文摘

Although ambient air pollution has been linked to reduced lung function in healthy children, longitudinal analyses of pollution effects in asthmatic patients are lacking.

Objective

We sought to investigate pollution effects in a longitudinal asthma study and effect modification by controller medications.

Methods

We examined associations of lung function and methacholine responsiveness (PC₂₀) with ozone, carbon monoxide (CO), nitrogen dioxide, and sulfur dioxide concentrations in 1003 asthmatic children participating in a 4-year clinical trial. We further investigated whether budesonide and nedocromil modified pollution effects. Daily pollutant concentrations were linked to ZIP/postal code of residence. Linear mixed models tested associations of within-subject pollutant concentrations with FEV₁ and forced vital capacity (FVC) percent predicted, FEV₁/FVC ratio, and PC₂₀, adjusting for seasonality and confounders.

Results

Same-day and 1-week average CO concentrations were negatively associated with postbronchodilator percent predicted FEV₁ (change per interquartile range, −0.33 [95% CI, −0.49 to −0.16] and −0.41 [95% CI, −0.62 to −0.21], respectively) and FVC (−0.19 [95% CI, −0.25 to −0.07] and −0.25 [95% CI, −0.43 to −0.07], respectively). Longer-term 4-month CO averages were negatively associated with prebronchodilator percent predicted FEV₁ and FVC (−0.36 [95% CI, −0.62 to −0.10] and −0.21 [95% CI, −0.42 to −0.01], respectively). Four-month averaged CO and ozone concentrations were negatively associated with FEV₁/FVC ratio (P < .05). Increased 4-month average nitrogen dioxide concentrations were associated with reduced postbronchodilator FEV₁ and FVC percent predicted. Long-term exposures to sulfur dioxide were associated with reduced PC₂₀ (percent change per interquartile range, −6% [95% CI, −11% to −1.5%]). Treatment augmented the negative short-term CO effect on PC₂₀.

Conclusions

Air pollution adversely influences lung function and PC₂₀ in asthmatic children. Treatment with controller medications might not protect but rather worsens the effects of CO on PC₂₀. This clinical trial design evaluates modification of pollution effects by treatment without confounding by indication.