The Effect of Ozone on Inner-City Children with Asthma

Mortimer, Kathleen; Tager, Ira B.; Dockery, Douglas W.; Neas, Lucas M.; Redline, Susan

doi:10.1164/ajrccm.162.5.9908113

Cited by 58 publications

(41 citation statements)

References 33 publications

(31 reference statements)

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“…Individual-level risk factors that modified the response to ozone in this cohort have been reported previously [11]. In particular, it was found that asthmatic children born prematurely (v37 weeks) or with a low birth weight (v2.5 kg) had a significantly greater response to increases in ozone.…”

supporting

confidence: 71%

The effect of air pollution on inner-city children with asthma

Mortimer¹,

Neas²,

Dockery³

et al. 2002

Eur Respir J

199

117

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The effect of daily ambient air pollution was examined within a cohort of 846 asthmatic children residing in eight urban areas of the USA, using data from the National Cooperative Inner-City Asthma Study.Daily air pollution concentrations were extracted from the Aerometric Information Retrieval System database from the Environment Protection Agency in the USA. Mixed linear models and generalized estimating equation models were used to evaluate the effects of several air pollutants (ozone, sulphur dioxide (SO 2 ), nitrogen dioxide (NO 2 ) and particles with a 50% cut-off aerodynamic diameter of 10 mm (PM10) on peak expiratory flow rate (PEFR) and symptoms in 846 children with a history of asthma (ages 4-9 yrs).None of the pollutants were associated with evening PEFR or symptom reports. Only ozone was associated with declines in morning % PEFR (0.59% decline (95% confidence interval (CI) 0.13-1.05%) per interquartile range (IQR) increase in 5-day average ozone). In single pollutant models, each pollutant was associated with an increased incidence of morning symptoms: (odds ratio (OR)=1.16 (95% CI 1.02-1.30) per IQR increase in 4-day average ozone, OR=1.32 (95% CI 1.03-1.70) per IQR increase in 2-day average SO 2 , OR=1.48 (95% CI 1.02-2.16) per IQR increase in 6-day average NO 2 and OR=1.26 (95% CI 1.0-1.59) per IQR increase in 2-day average PM10.This longitudinal analysis supports previous time-series findings that at levels below current USA air-quality standards, summer-air pollution is significantly related to symptoms and decreased pulmonary function among children with asthma. Much of the evidence for the effect of air pollution on respiratory health [1-8] is based on time-series analyses of repeated measurements in closed cohorts, which create a daily summary of responses across all study individuals. Fluctuations in this summary measure are evaluated relative to daily fluctuations in air pollution. Therefore, these approaches are not well suited to investigations of individual-level factors related to heterogeneity of response. Time-series analyses require that the distribution of individuallevel factors in the study population remain stable over time [9] or that data on changes in these characteristics are included in the model. This limits their usefulness in studying populations which do not remain fixed during the study period.Longitudinal analysis techniques such as mixed linear models and generalized estimating equations provide a more statistically powerful alternative by incorporating individual level outcomes and covariates.They permit estimation of individual mean effects and individual change over time as well as population mean effects over the entire study period. These methods require no assumptions about stability of population characteristics over time and subjects with incomplete data can be included in the analysis [10]. Therefore these methods are well-suited for epidemiological studies.These methods were used to evaluate air pollutionrelated health effects in a large cohort of...

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supporting

confidence: 71%

The effect of air pollution on inner-city children with asthma

Mortimer¹,

Neas²,

Dockery³

et al. 2002

Eur Respir J

199

117

View full text Add to dashboard Cite

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“…Several other panel studies have examined the importance of medication use to air pollutant associations (2,(25)(26)(27). Two of these studies showed stronger associations between asthma outcomes and air pollutants among subjects taking any asthma medication versus subjects not taking asthma medication, but they did not separate subjects by anti-inflammatory medication use (25,26).…”

Section: Discussionmentioning

confidence: 99%

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

Delfino

Zeiger

Seltzer

et al. 2002

Environ Health Perspect

184

135

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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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“…Children are considered to be more sensitive to air pollution than adults [4], and asthmatic children are particularly vulnerable to the adverse health effects of air pollution. Studies of asthmatic children have concluded that exposure to high concentrations of ozone or PM significantly enhances the risk of respiratory symptoms, asthma medication use, and reduced lung function, such as decline in peak expiratory flow or forced expiratory flow in a short time [5][6][7][8][9][10]. However, while a number of studies have been conducted in the field of air pollution epidemiology, few have examined the association between meteorological elements and asthma attack, and the adverse health effects of low-level exposure to air pollutants remain unclear.…”

Section: Introductionmentioning

confidence: 99%

Association of ambient air pollution and meteorological factors with primary care visits at night due to asthma attack

Yamazaki

Shima

Yoda

et al. 2013

Environ Health Prev Med

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Aim The association of outdoor air pollution and meteorological elements with primary care visits at night due to asthma attack was studied. Methods A case-crossover study was conducted in a primary care clinic in Himeji City, Japan. The subjects were 956 children aged 0-14 years who visited the clinic with an asthma attack between the hours of 9 p.m. and 6 a.m. Daily concentrations of particulate matter, ozone, nitrogen dioxide, and a number of meteorological elements were measured, and a conditional logistic regression model was used to estimate odds ratios (ORs) of primary care visits per unit increment of air pollutants or meteorological elements. The analyses took into consideration the effects of seasonality. Results Of the 956 children, 73 (7.6 %) were aged \2 years and 417 (43.6 %) were aged 2-5 years. No association between daily ozone levels and primary care visits due to asthma attack at night in the spring or summer was found. An inverse relation between suspended particulate matter and primary care visits due to asthma attack was detected in the winter. ORs in the summer per degree increment in daily mean temperature was 1.31 [95 % confidential interval (CI) 1.09-1.56], and ORs in the autumn per hourly increment in daily hours of sunshine was 0.94 (95 % CI 0.90-0.99). Conclusion The findings of our study fail to support any association between daily mean concentration of air pollutant and primary care visits at night. However, we did find evidence indicating that certain meteorological elements may be associated with primary care visits

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The Effect of Ozone on Inner-City Children with Asthma

Cited by 58 publications

References 33 publications

The effect of air pollution on inner-city children with asthma

The effect of air pollution on inner-city children with asthma

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

Association of ambient air pollution and meteorological factors with primary care visits at night due to asthma attack

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