Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA 90039, USA.
Department of Computer Science, University of California Los Angeles, Los Angeles, CA 90095, USA.
Int J Environ Res Public Health. 2022 Mar 17;19(6):3578. doi: 10.3390/ijerph19063578.
Background: Exposure to air pollution is associated with acute pediatric asthma exacerbations, including reduced lung function, rescue medication usage, and increased symptoms; however, most studies are limited in investigating longitudinal changes in these acute effects. This study aims to investigate the effects of daily air pollution exposure on acute pediatric asthma exacerbation risk using a repeated-measures design. Methods: We conducted a panel study of 40 children aged 8−16 years with moderate-to-severe asthma. We deployed the Biomedical REAI-Time Health Evaluation (BREATHE) Kit developed in the Los Angeles PRISMS Center to continuously monitor personal exposure to particulate matter of aerodynamic diameter < 2.5 µm (PM2.5), relative humidity and temperature, geolocation (GPS), and asthma outcomes including lung function, medication use, and symptoms for 14 days. Hourly ambient (PM2.5, nitrogen dioxide (NO2), ozone (O3)) and traffic-related (nitrogen oxides (NOx) and PM2.5) air pollution exposures were modeled based on location. We used mixed-effects models to examine the association of same day and lagged (up to 2 days) exposures with daily changes in % predicted forced expiratory volume in 1 s (FEV1) and % predicted peak expiratory flow (PEF), count of rescue inhaler puffs, and symptoms. Results: Participants were on average 12.0 years old (range: 8.4−16.8) with mean (SD) morning %predicted FEV1 of 67.9% (17.3%) and PEF of 69.1% (18.4%) and 1.4 (3.5) puffs per day of rescue inhaler use. Participants reported chest tightness, wheeze, trouble breathing, and cough symptoms on 36.4%, 17.5%, 32.3%, and 42.9%, respectively (n = 217 person-days). One SD increase in previous day O3 exposure was associated with reduced morning (beta [95% CI]: −4.11 [−6.86, −1.36]), evening (−2.65 [−5.19, −0.10]) and daily average %predicted FEV1 (−3.45 [−6.42, −0.47]). Daily (lag 0) exposure to traffic-related PM2.5 exposure was associated with reduced morning %predicted PEF (−3.97 [−7.69, −0.26]) and greater odds of “feeling scared of trouble breathing” symptom (odds ratio [95% CI]: 1.83 [1.03, 3.24]). Exposure to ambient O3, NOx, and NO was significantly associated with increased rescue inhaler use (rate ratio [95% CI]: O3 1.52 [1.02, 2.27], NOx 1.61 [1.23, 2.11], NO 1.80 [1.37, 2.35]). Conclusions: We found significant associations of air pollution exposure with lung function, rescue inhaler use, and “feeling scared of trouble breathing.” Our study demonstrates the potential of informatics and wearable sensor technologies at collecting highly resolved, contextual, and personal exposure data for understanding acute pediatric asthma triggers.
暴露于空气污染与儿童急性哮喘加重有关，包括肺功能下降、急救药物使用增加和症状加重；然而，大多数研究都局限于调查这些急性影响的纵向变化。本研究旨在使用重复测量设计来研究每日空气污染暴露对儿童急性哮喘发作风险的影响。
我们对 40 名 8-16 岁的中度至重度哮喘儿童进行了一项面板研究。我们使用在洛杉矶 PRISMS 中心开发的生物医学实时健康评估（BREATHE）工具套件，连续监测个人对空气动力学直径<2.5 µm（PM2.5）的颗粒物、相对湿度和温度、地理位置（GPS）以及哮喘结果（包括肺功能、药物使用和症状）14 天。基于位置对环境（PM2.5、二氧化氮（NO2）、臭氧（O3））和交通相关（氮氧化物（NOx）和 PM2.5）空气污染暴露进行了小时级建模。我们使用混合效应模型来检查当天和滞后（最多 2 天）暴露与每日 %预测用力呼气量（FEV1）和 %预测峰流速（PEF）、急救吸入器剂量、症状变化的关联。
参与者的平均年龄为 12.0 岁（范围：8.4-16.8），平均（SD）清晨 %预测 FEV1 为 67.9%（17.3%），PEF 为 69.1%（18.4%），每日急救吸入器使用量为 1.4（3.5）吸。参与者报告胸部紧绷、喘息、呼吸困难和咳嗽症状的分别占 36.4%、17.5%、32.3%和 42.9%（n = 217 人日）。前一天 O3 暴露的增加与清晨（β[95%CI]：-4.11[-6.86，-1.36]）、傍晚（-2.65[-5.19，-0.10]）和每日平均 %预测 FEV1（-3.45[-6.42，-0.47]）降低有关。每日（滞后 0）接触交通相关 PM2.5 与清晨 %预测 PEF 降低（-3.97[-7.69，-0.26]）和“呼吸困难时感到恐惧”症状的发生几率增加有关（比值比[95%CI]：1.83[1.03，3.24]）。环境 O3、NOx 和 NO 暴露与急救吸入器使用量增加显著相关（率比[95%CI]：O3 1.52[1.02，2.27]，NOx 1.61[1.23，2.11]，NO 1.80[1.37，2.35]）。
我们发现空气污染暴露与肺功能、急救吸入器使用和“呼吸困难时感到恐惧”之间存在显著关联。我们的研究表明，信息学和可穿戴传感器技术在收集高度精确、上下文和个人暴露数据以了解儿童急性哮喘触发因素方面具有潜力。
