Associations of personal exposure to air pollutants with airway mechanics in children with asthma

Abstract

Background: The importance of airway mechanics has been increasingly recognized in pediatric asthma. However, no studies have examined responses of airway mechanics to air pollution exposure in asthmatic children. Methods: In this panel study involving indoor air filtration manipulation that created a large gradient of personal exposure to PM2.5, the airway mechanics and lung function of 43 asthmatic children 5–13 years old in a suburb of Shanghai were measured four times within 3 consecutive months. Concentrations of indoor and outdoor PM2.5 and ozone were coupled with individual time-activity data to calculate personal exposures. Linear mixed effects models were used to examine the relationships of personal exposure with indicators of airway mechanics and lung function, respectively. Results: An interquartile range (IQR) increase in 24-hour average PM2.5 personal exposure (30.3 µg/m3) in the prior day was associated with significant increases in small airway resistance (R5-R20) of 15.8%, total airway resistance (R5) of 6.3%, and airway inflammation (FeNO) of 9.6%. These associations were stronger in children with lower blood eosinophil counts (<450/µL). No significant associations were found between personal PM2.5 exposure and lung function. Low-level ozone exposure (daily maximum 8-hour exposure range 1.1–56.4 ppb) was not significantly associated with any of the outcomes. Conclusion: Changes in personal PM2.5 exposure, partly enhanced by air filtration, were associated with significant changes in airway resistance and inflammation in children with asthma. These findings suggest the importance of reducing PM2.5 exposure, via personal air quality management, in improving airflow limitation in the airways, especially the small airways. Keywords: Airway mechanics, Asthmatic children, Air pollution exposure, Pulmonary physiology, Asthma management, Impulse oscillometry