Household gas appliances produce nitrogen dioxide (NO 2 ), which may be associated with an increase in symptoms in asthmatics. The relationship between indoor NO 2 exposure, and respiratory symptoms in people with asthma was evaluated.Self-reported asthmatics (n=125) wore lapel badges that measured NO 2 daily over 6 weeks at home. Outdoor pollutants, spores and meteorological parameters were measured daily, in addition to smoking status and demographic factors. Seven asthma symptoms were recorded in diaries, for analysis by same day and also with 1 day lag exposures, using a generalized estimating equation.Significant interactions were demonstrated between NO 2 at age #14 yrs, with respect to the symptoms of chest tightness on the same day (odds ratio ( Nitrogen dioxide (NO 2 ) is predominantly an indoor pollutant, and the major source of exposure is from household appliances fuelled by gas, particularly in households without flues for the gas appliances [1]. There is evidence that NO 2 is associated with an increase in respiratory symptoms among the general population, particularly in children, in a range of epidemiological studies that the authors have previously reviewed [2]. Studies under controlled conditions have indicated a relationship between NO 2 exposure and airway hyperresponsiveness in asthmatic children [3], and also with an enhanced bronchoconstrictor response to inhaled house dust mite and pollen antigens [4±8].There are few community based studies on asthmatics, where patterns of exposure are more complex. A casecontrol study concerning the onset of asthma by INFANTE-RIVARD [9] demonstrated a dose-response relationship between asthma and a single personal NO 2 exposure over 24 hrs [9]. HOEK et al. [10] found no relationship in a further case-control study, but used a weekly residential NO 2 measurement. A cohort study of 164 asthmatic subjects by OSTRO et al.[11] demonstrated a significant relationship between daily recordings of gas appliance use and the incidence of repeated attacks of asthma symptoms, but they did not measure actual NO 2 levels. The effects of short-term personal NO 2 exposure, in a cohort study, has never been measured on a daily basis in asthmatics. In view of the potential public health significance of even a small effect of NO 2 upon asthmatics, the aim was to perform a prospective study in asthmatics, in a residential household setting, to evaluate the relationship between asthma symptoms and short-term personal NO 2 exposure measurements during periods of household gas appliance use.
MethodsAsthmatic participants were identified from a crosssectional health survey of Port Adelaide residents in South Australia [12], that utilized standard Australian Bureau of Statistics National Health Survey (NHS) sampling methodology and health related questions [13]. A high level of validity and reliability for self-reported asthma in the Australian setting has been previously recorded [14]. Criteria for selection to participate in the cohort study were based on the partici...