School Endotoxin Exposure and Asthma Morbidity in Inner-city Children

Lai, Peggy S.; Sheehan, William J.; Gaffin, Jonathan M.; Petty, Carter R.; Coull, Brent A.; Gold, Diane R.; Phipatanakul, Wanda

doi:10.1378/chest.15-0098

Cited by 55 publications

(52 citation statements)

References 25 publications

(29 reference statements)

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“…[5,16,44–53] Our ongoing efforts are evaluating the additive role of the school environment, adjusting for home environment on health outcomes, and may provide additional support for school-based environmental intervention as a next step. The school may eventually be considered an effective target for asthma morbidity prevention.…”

Section: Discussionmentioning

confidence: 99%

The School Inner-City Asthma Intervention Study: Design, rationale, methods, and lessons learned

Phipatanakul

Koutrakis

Coull

et al. 2017

Contemporary Clinical Trials

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Asthma is the most common chronic disease of childhood in the United States, causes significant morbidity, particularly in the inner-city, and accounts for billions of dollars in health care utilization. Home environments are established sources of exposure that exacerbate symptoms and home-based interventions are effective. However, elementary school children spend 7 to 12 h a day in school, primarily in one classroom. From the observational School Inner-City Asthma Study we learned that student classroom-specific exposures are associated with worsening asthma symptoms and decline in lung function. We now embark on a randomized, blinded, sham-controlled school environmental intervention trial, built on our extensively established school/community partnerships, to determine the efficacy of a school-based intervention to improve asthma control. This factorial school/classroom based environmental intervention will plan to enroll 300 students with asthma from multiple classrooms in 40 northeastern inner-city elementary schools. Schools will be randomized to receive either integrated pest management versus control and classrooms within these schools to receive either air purifiers or sham control. The primary outcome is asthma symptoms during the school year. This study is an unprecedented opportunity to test whether a community of children can benefit from school or classroom environmental interventions. If effective, this will have great impact as an efficient, cost-effective intervention for inner city children with asthma and may have broad public policy implications.

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Section: Discussionmentioning

confidence: 99%

The School Inner-City Asthma Intervention Study: Design, rationale, methods, and lessons learned

Phipatanakul

Koutrakis

Coull

et al. 2017

Contemporary Clinical Trials

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“…Endotoxin exposure in homes and occupational settings have demonstrated increased wheeze, increased airflow obstruction and bronchial hyper-reactivity in human challenge studies, and potentiated the airway response to allergens in people with asthma [48 ▪▪ ,49]. Several studies have identified elevated airborne endotoxin levels in schools [50–52].…”

Section: Reviewmentioning

confidence: 99%

“…The HITEA study above, demonstrated endotoxin, ergosterol, and Penicillium chrysogenum DNA levels were higher in moisture-damaged schools as compared with reference schools [42,43 ▪▪ ]. A 2015 study published by Lai et al [48 ▪▪ ], assessed the relationship between school endotoxin exposure and asthma morbidity in the SICAS longitudinal cohort. This study found that school dust endotoxin levels were significantly higher than home levels; 22% of classroom air levels exceeded 90 EU/m, a recommended occupational exposure limit for adults [48 ▪▪ ].…”

Section: Reviewmentioning

confidence: 99%

“…A 2015 study published by Lai et al [48 ▪▪ ], assessed the relationship between school endotoxin exposure and asthma morbidity in the SICAS longitudinal cohort. This study found that school dust endotoxin levels were significantly higher than home levels; 22% of classroom air levels exceeded 90 EU/m, a recommended occupational exposure limit for adults [48 ▪▪ ]. In this novel study, increased school air endotoxin is associated with increased number of maximum symptom days in children with nonatopic asthma, after adjusting for home exposures.…”

Section: Reviewmentioning

confidence: 99%

“…In this novel study, increased school air endotoxin is associated with increased number of maximum symptom days in children with nonatopic asthma, after adjusting for home exposures. This study postulates that high levels of school endotoxin exposure may explain why inner-city children experience a higher burden of disease and higher morbidity because of asthma and represents an important potential area of intervention [48 ▪▪ ]. …”

Section: Reviewmentioning

confidence: 99%

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Recent advances in environmental controls outside the home setting

Hauptman

Phipatanakul

2016

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of review It has been well studied that aeroallergen, mold, and airborne pollutant exposure in the inner-city home environment is associated with significant childhood asthma morbidity. Although the home environment has been extensively studied, the school environment is less well understood. Recent findings In this article, we discuss the relationship between environmental exposures within the school and daycare environment and pediatric asthma morbidity and novel environmental interventions designed to help mitigate pediatric asthma morbidity. Summary Studies assessing environmental exposures outside the home environment and interventions to mitigate these exposures have the potential to reduce pediatric asthma morbidity. Further study in this area should focus on the complex cost benefit analyses of environmental interventions outside the home setting, while controlling for the home environment.

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