Health effects of indoor nitrogen dioxide and passive smoking on urban asthmatic children
Health effects of indoor nitrogen dioxide and passive smoking on urban asthmatic children
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DOI：
10.1016/j.jaci.2007.05.014
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发表时间：
2007-09-01
影响因子：
14.2
通讯作者：
Mitchell, Herman E.
中科院分区：
文献类型：
--
作者：
Kattan, Meyer;Gergen, Peter J.;Mitchell, Herman E.
背景：二氧化氮(NO2)和环境烟草烟雾(ETS)与不良的呼吸道反应有关。目的：探讨NO2和ETS对市区儿童哮喘发病率的影响。方法：对4~9岁哮喘儿童暴露于NO2和ETS中，通过在家中使用棕榈管和尿可替宁进行测量。3、6和9个月的基线访谈和电话评估评估了卫生服务利用、哮喘症状和峰值流量。结果：在469户家庭中，87.8%的家庭使用了煤气灶。室内二氧化氮的中位数为29.8 ppb，而美国全国室外的中位数为18 ppb。在1444名儿童中，48%的儿童尿可替宁/肌酐比值大于30毫微克/毫克。吸烟家庭的可替宁/肌酐比值的中位数为42.4 ng/mg，而非吸烟家庭的中位数为18.0 ng/mg。在皮肤试验无阳性反应的儿童中，伴随NO2暴露增加而出现哮喘症状的相对风险为1.75(95%CI，1.10-2.78)。较高的NO2暴露导致较冷月份的峰值流量较低(相对风险为1.46；95%可信区间为1.07-1.97)。在较冷的月份，较高的ETS暴露与较低的峰值流量(相对风险，1.21；95%可信区间，0.99-1.47)的相关性较弱。结论：室内NO2水平升高与非特应性儿童哮喘症状增加和峰值流量降低有关。临床意义：减少NO2暴露的干预措施，如燃气灶的排气，可能有助于降低哮喘发病率。
Background: Nitrogen dioxide (NO2) and environmental tobacco smoke (ETS) have been associated with adverse respiratory effects.Objective: We sought to assess the effect of NO2 and ETS on asthma morbidity among children in inner-city environments.Methods: Asthmatic children between the ages of 4 and 9 years had exposure to NO2 and ETS measured by using Palmes tubes in the home and urinary cotinine. A baseline interview and telephone assessments at 3, 6, and 9 months evaluated health service use, asthma symptoms, and peak flow rates.Results: Gas stoves were present in 87.8% of 469 homes. The median level of indoor NO2 was 29.8 ppb compared with the US national outdoor median of 18 ppb. Of 1444 children, 48% had urinary cotinine/creatinine ratios of greater than 30 ng/mg. The median level of the cotinine/creatinine ratio was 42.4 ng/mg in smoking homes compared with 18.0 ng/mg in nonsmoking homes. The relative risk for asthma symptoms with increased NO2 exposure was 1.75 (95% CI, 1.10-2.78) in children who did not have positive skin test responses. Higher NO2 exposure resulted in lower peak flows during colder months (relative risk, 1.46; 95% CI, 1.07-1.97). Higher ETS exposure in colder months was weakly associated with lower peak flows (relative risk, 1.21; 95% CI, 0.99-1.47). There was no effect of ETS exposure on symptoms or use of health care services.Conclusion: Higher levels of indoor NO2 are associated with increased asthma symptoms in nonatopic children and decreased peak flows.Clinical implications: Interventions to reduce NO2 exposure, such as venting of gas stoves, might help reduce asthma morbidity.