A Longitudinal Study of Indoor Nitrogen Dioxide Levels and Respiratory Symptoms in Inner-City Children with Asthma

Hansel, Nadia N.; Breysse, Patrick N.; McCormack, Meredith C.; Matsui, Elizabeth C.; Curtin-Brosnan, Jean; Williams, D’Ann L.; Moore, Jennifer L.; Cuhran, Jennifer L.; Diette, Gregory B.

doi:10.1289/ehp.11349

Cited by 153 publications

(99 citation statements)

References 35 publications

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“…Current recommendations for improving home indoor air quality focus mostly on avoiding indoor SHS. However, our findings are likely independent of SHS exposure, and there are other important modifiable sources of indoor PM and NO 2 (20,40). Future studies investigating the effectiveness of environmental interventions aimed at reducing indoor pollutant concentrations in homes of patients with COPD, such air cleaner intervention trials that have shown reduction in indoor PM and improved symptoms in asthma (10), are warranted as potential nonpharmacologic approaches to improving COPD health.…”

Section: Discussionmentioning

confidence: 75%

“…Our results are derived from a population in Baltimore City and surrounding areas and the indoor environment may not be generalizable to other communities. In addition, we did not measure outdoor or personal exposure to PM and NO 2 ; however, previous results from Baltimore City homes show that although outdoor PM and NO 2 concentrations contribute to indoor concentrations, indoor sources, such as smoking, cooking, combustion sources, and cleaning practices, are the dominant determinants of indoor pollutant concentrations (20,40). To confirm a similar association in our sample of homes of subjects with COPD, in a subgroup (n ¼ 26) of our participants who lived within 3 miles of an outdoor monitoring station, we found that outdoor PM 2.5 concentrations explained only 5% of the variance in indoor PM 2.5 concentrations; outdoor NO 2 concentrations explained approximately 25% of the variance in indoor NO 2 concentrations.…”

Section: Discussionmentioning

confidence: 99%

“…Air sampling was performed for 1 week at baseline, 3 months, and 6 months in the participant's bedroom and the main living area, identified as an additional room where the participant reported spending the most time. Indoor air sampling for PM 2.5 (PM with aerodynamic size < 2.5 mm) and NO 2 was conducted as described previously and in the online supplement (20). The limit of detection for PM 2.5 was 0.64 mg/m 3 .…”

Section: Air Quality Assessmentmentioning

confidence: 99%

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In-Home Air Pollution Is Linked to Respiratory Morbidity in Former Smokers with Chronic Obstructive Pulmonary Disease

Hansel¹,

McCormack²,

Belli³

et al. 2013

Am J Respir Crit Care Med

Self Cite

102

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Rationale: The effect of indoor air pollutants on respiratory morbidity among patients with chronic obstructive pulmonary disease (COPD) in developed countries is uncertain. Objectives: The first longitudinal study to investigate the independent effects of indoor particulate matter (PM) and nitrogen dioxide (NO 2 ) concentrations on COPD morbidity in a periurban community. Methods: Former smokers with COPD were recruited and indoor air was monitored over a 1-week period in the participant's bedroom and main living area at baseline, 3 months, and 6 months. At each visit, participants completed spirometry and questionnaires assessing respiratory symptoms. Exacerbations were assessed by questionnaires administered at clinic visits and monthly telephone calls. Measurements and Main Results: Participants (n ¼ 84) had moderate or severe COPD with a mean FEV 1 of 48.6% predicted. The mean (6 SD) indoor PM 2.5 and NO 2 concentrations were 11.4 6 13.3 µg/m 3 and 10.8 6 10.6 ppb in the bedroom, and 12.2 6 12.2 µg/m 3 and 12.2 6 11.8 ppb in the main living area. Increases in PM 2.5 concentrations in the main living area were associated with increases in respiratory symptoms, rescue medication use, and risk of severe COPD exacerbations. Increases in NO 2 concentrations in the main living area were independently associated with worse dyspnea. Increases in bedroom NO 2 concentrations were associated with increases in nocturnal symptoms and risk of severe COPD exacerbations. Conclusions: Indoor pollutant exposure, including PM 2.5 and NO 2 , was associated with increased respiratory symptoms and risk of COPD exacerbation. Future investigations should include intervention studies that optimize indoor air quality as a novel therapeutic approach to improving COPD health outcomes.Keywords: indoor air; chronic obstructive pulmonary disease; particulate matter; nitrogen dioxide; exacerbations Chronic obstructive pulmonary disease (COPD), the third leading cause of death in the United States and the fifth leading cause worldwide, is expected to become increasingly prevalent in upcoming decades (1, 2). Most COPD is caused by environmental exposures; in developed countries, this exposure is primarily cigarette smoke. After COPD begins, evidence indicates that it can be worsened by other environmental exposures. For example, outdoor particulate matter (PM) concentrations have been associated with an increase in COPD hospitalizations and mortality (3, 4). Similarly, outdoor nitrogen dioxide (NO 2 ) exposure has been linked to worse COPD morbidity, including higher rates of exacerbations (4-6).Although substantial evidence shows that outdoor air pollutants impact COPD, there is much less evidence for the impact of indoor air on COPD, especially in developed countries. Although the Global Initiative for Chronic Obstructive Lung Disease guidelines identify indoor air pollution resulting from burning wood and other biomass fuels as a major risk factor for COPD (7), exposures under these conditions are two to three orders of magnitude higher ...

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Air Quality Assessmentmentioning

confidence: 99%

See 1 more Smart Citation

In-Home Air Pollution Is Linked to Respiratory Morbidity in Former Smokers with Chronic Obstructive Pulmonary Disease

Hansel¹,

McCormack²,

Belli³

et al. 2013

Am J Respir Crit Care Med

Self Cite

102

View full text Add to dashboard Cite

show abstract

“…Results of longitudinal studies on asthmatic populations or subjects at risk of developing asthma are quite conclusive: an increase in nitrogen dioxide concentration was associated with increased reporting of respiratory symptoms, including wheezing, breathing difficulty, chest tightness, shortness of breath and cough [98][99][100][101][102][103]. However, data at the general population level are more controversial.…”

Section: Nitrogen Dioxidementioning

confidence: 99%

Respiratory health and indoor air pollutants based on quantitative exposure assessments

et al. 2012

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We reviewed the main epidemiological studies that evaluate the respiratory effects of indoor air pollutants quantitatively in industrialised countries. Consistent results support short-term (aggravation) and, although more rarely, long-term (prevalence augmentation) effects on asthma, chronic bronchitis and chronic obstructive pulmonary disease (COPD) in indoor settings with poor air quality. Environmental tobacco smoke is one of the most important risks for respiratory symptoms and diseases worldwide. The evidence is also reliable for indoor nitrogen dioxide and particulate matter, which have been associated with asthma, bronchitis and COPD. Whereas formaldehyde and volatile organic compounds seem to be the main pollutants in indoor settings, relevant papers on their respiratory effects are still scarce, and limited to asthma and bronchitis. Moulds have been associated with an increased risk of asthma and COPD. Contradictory results have been found between endotoxins and asthma. The role of phthalates, persistent organic pollutants and flame retardants in respiratory diseases remains to be established. Results from rural areas of industrialised countries indicate that exposure to some indoor bio-contaminants might be protective in early life, while it is associated with adverse respiratory adverse effects in adulthood. Studies focusing on indoor air pollutants should be developed to better understand their involvement in the inception and aggravation of respiratory diseases.

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“…Hansel and colleagues (36) recently reported on the effect of indoor NO 2 concentrations and asthma in the BIESAK longitudinal cohort. Most of the homes in the BIESAK study were row homes (homes that share adjacent walls; 79%) and close to the street (within 25 ft; 71%).…”

Section: Indoor Nitrogen Dioxide and Asthma Morbiditymentioning

confidence: 99%

Indoor Air Pollution and Asthma in Children

Breysse¹,

Diette²,

Matsui³

et al. 2010

Proceedings of the American Thoracic Society

189

108

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A Longitudinal Study of Indoor Nitrogen Dioxide Levels and Respiratory Symptoms in Inner-City Children with Asthma

Cited by 153 publications

References 35 publications

In-Home Air Pollution Is Linked to Respiratory Morbidity in Former Smokers with Chronic Obstructive Pulmonary Disease

In-Home Air Pollution Is Linked to Respiratory Morbidity in Former Smokers with Chronic Obstructive Pulmonary Disease

Respiratory health and indoor air pollutants based on quantitative exposure assessments

Indoor Air Pollution and Asthma in Children

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