Zetlen Hilary L, Rifas-Shiman Sheryl L, Gibson Heike, Oken Emily, Gold Diane R, Rice Mary B
Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Ann Am Thorac Soc. 2025 Feb;22(2):226-234. doi: 10.1513/AnnalsATS.202405-455OC.
Further evaluation of the impact of long-term exposure to the gaseous air pollutants nitrogen dioxide (NO) and ozone (O) on child lung function and of NO or O on eosinophilic airway inflammation is needed. To determine whether NO and O are associated with lung function and fractional exhaled nitric oxide (Fe) in children. We measured lung function (forced expiratory volume in 1 second [FEV] and forced vital capacity [FVC]) at midchildhood (mean age, 7.9 yr; = 703), early teens (13.2 yr; = 976), and midteens (17.6 yr; = 624) study visits, and Fe at the early and midteens study visits in Project Viva, a cohort of mother-child pairs in the Boston area. Long-term exposure to NO and O was estimated at the home address using geospatial models. We examined associations of home address NO and O exposure and proximity to roadway with lung function and Fe using linear regression models, adjusting for age, sex, height, weight, season, relative humidity, temperature, parental smoking, and measures of socioeconomic status. We examined for effect modification of the midteen associations by blood eosinophil concentration, physical activity, aeroallergen sensitization, and parental atopy. Median exposure to NO was 33.1 ppb (interquartile range [IQR], 10.4 ppb) and to O was 35.3 ppb (IQR, 3.4) in the first year of life. Exposure to NO was associated with lower FEV and FVC across all age groups and exposure time intervals: For example, an IQR increment of NO exposure from birth through the early teen visit was associated with 189.9 ml lower FEV (95% confidence interval, -273.3, -106.5) at the midteen visit. Lifetime NO exposure at was associated with higher Fe at the early teen visit: for example, 16.2% higher Fe (95% confidence interval, 7.1-26.4%) per IQR of lifetime NO through the early teen visit. O exposure was not associated with lung function or Fe. Aeroallergen sensitization (measured in a subset of participants) modified associations of NO and O with Fe. Exposure to NO was associated with lower lung function and higher Fe among generally healthy children and teenagers. Because NO exposure levels were within the annual U.S. Environmental Protection Agency standard, these findings suggest a need to reduce exposure to this pollutant to optimize child respiratory health.
需要进一步评估长期暴露于气态空气污染物二氧化氮（NO）和臭氧（O）对儿童肺功能的影响，以及NO或O对嗜酸性气道炎症的影响。以确定NO和O是否与儿童的肺功能和呼出一氧化氮分数（Fe）相关。在“活力计划”（波士顿地区的一组母婴队列研究）中，我们在儿童中期（平均年龄7.9岁；n = 703）、青少年早期（13.2岁；n = 976）和青少年中期（17.6岁；n = 624）的研究访视中测量了肺功能（1秒用力呼气量[FEV]和用力肺活量[FVC]），并在青少年早期和中期的研究访视中测量了Fe。使用地理空间模型在家庭住址估计长期暴露于NO和O的情况。我们使用线性回归模型，调整年龄、性别、身高、体重、季节、相对湿度、温度、父母吸烟情况和社会经济地位指标，研究家庭住址NO和O暴露以及与道路的距离与肺功能和Fe之间的关联。我们研究了血液嗜酸性粒细胞浓度、身体活动、气传变应原致敏和父母特应性对青少年中期关联的效应修正作用。在生命的第一年，NO的中位暴露量为33.1 ppb（四分位间距[IQR]，10.4 ppb），O的中位暴露量为35.3 ppb（IQR，3.4）。在所有年龄组和暴露时间间隔内，NO暴露与较低的FEV和FVC相关：例如，从出生到青少年早期访视期间，NO暴露量每增加一个IQR，在青少年中期访视时FEV降低189.9 ml（95%置信区间，-273.3，-106.5）。在青少年早期访视时，一生的NO暴露与较高的Fe相关：例如，在青少年早期访视期间，一生的NO暴露量每增加一个IQR，Fe升高16.2%（95%置信区间，7.1 - 26.4%）。O暴露与肺功能或Fe无关。气传变应原致敏（在一部分参与者中测量）修正了NO和O与Fe之间的关联。在一般健康的儿童和青少年中，NO暴露与较低的肺功能和较高的Fe相关。由于NO暴露水平在美国环境保护局年度标准范围内，这些发现表明需要减少对这种污染物的暴露，以优化儿童呼吸健康。
