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

¹ Dept of Epidemiology, Harvard School of Public Health, Boston, MA, ² Epidemiology and Biomarkers Branch, US Environmental Protection Agency/National Health and Environmental Effects Research Laboratory, Human Studies Division, Chapel Hill, NC, ³ Dept of Epidemiology and Environmental Health, Harvard School of Public Health, Boston, MA, ⁴ Dept of Pediatrics, Case Western Reserve University, Rainbow Babies & Children's Hospital, Cleveland, OH and ⁵ Dept of Public Health Biology and Epidemiology, University of California, Berkeley, CA, USA

CORRESPONDENCE: K.M. Mortimer, School of Public Health, 1918 University Ave, University of California, Berkeley, CA 94720-7370, USA. Fax: 15 106430239. E-mail: kmort@uclink4.berkeley.edu

Keywords: air pollution, asthma, generalized estimating equations, inner-city, mixed linear models

Received: July 9, 2001
Accepted December 16, 2001

The NCICAS research was supported by grants U01 AI-30751, AI-30752, AI-30756, AI-30772, AI-30773, AI-30777, AI-30779, AI30780, and AI-15105 from NIAID, NIH.

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 (SO₂), nitrogen dioxide (NO₂) and particles with a 50% cut-off aerodynamic diameter of 10 µm (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 SO₂, OR=1.48 (95% CI 1.02–2.16) per IQR increase in 6-day average NO₂ 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.

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