BACKGROUND

Ambient and home exposure to nitrogen dioxide (NO) causes asthma symptoms and decreased lung function in children with asthma. Little is known about the health effects of school classroom pollution exposure.

OBJECTIVE

We aimed to determine the effect of indoor classroom NO on lung function and symptoms in inner-city school children with asthma.

METHODS

Children enrolled in the School Inner-City Asthma Study were followed for 1 academic year. Subjects performed spirometry and had fraction of exhaled nitric oxide values measured twice during the school year at school. Classroom NO was collected by means of passive sampling for 1-week periods twice per year, coinciding with lung function testing. Generalized estimating equation models assessed lung function and symptom relationships with the temporally nearest classroom NO level.

RESULTS

The mean NO value was 11.1 ppb (range, 4.3-29.7 ppb). In total, exposure data were available for 296 subjects, 188 of whom had complete spirometric data. At greater than a threshold of 8 ppb of NO and after adjusting for race and season (spirometry standardized by age, height, and sex), NO levels were associated highly with airflow obstruction, such that each 10-ppb increase in NO level was associated with a 5% decrease in FEV/forced vital capacity ratio (β = -0.05; 95% CI, -0.08 to -0.02; P = .01). Percent predicted forced expiratory flow between the 25th and 75th percentile of forced vital capacity was also inversely associated with higher NO exposure (β = -22.8; 95% CI, -36.0 to -9.7; P = .01). There was no significant association of NO levels with percent predicted FEV, fraction of exhaled nitric oxide, or asthma symptoms. Additionally, there was no effect modification of atopy on lung function or symptom outcomes.

CONCLUSION

In children with asthma, indoor classroom NO levels can be associated with increased airflow obstruction.