Phthalate Exposure and Inner City Pediatric Asthma

这项研究将证实或驳斥最近的流行病学发现，即邻苯二甲酸盐暴露与儿童哮喘、特应性疾病和肺功能减退之间的关系。这项先前的研究受到不完整的暴露和结果衡量标准的限制。然而，为这项拟议的研究进行的一项试点研究的结果也支持了这样的假设，即邻苯二甲酸盐暴露是哮喘发生的危险因素。这项拟议的研究将在居住在纽约市少数族裔社区的400名儿童中进行。这些社区经历了世界上儿童哮喘发病率最高的一些社区。接触邻苯二甲酸盐的情况也很普遍。这项研究将在哥伦比亚儿童环境健康中心(CCCEH)正在进行的纵向出生队列研究中进行。CCCEH正在评估产前和出生后暴露在哮喘和其他健康后果发展中的贡献。孩子从怀孕到七岁都会被跟踪。拟议的研究具有成本效益，因为许多所需的暴露和结果测量已经在CCCEH队列中收集。邻苯二甲酸酯将在从怀孕期间的母亲和3岁和5岁的孩子那里收集的储存尿样中，以及在5到7岁的新收集的室内空气和尿样中进行测量。此外，在5至7岁时，将测量呼出的一氧化氮作为呼吸道炎症的指标，并测定总IgE水平和过敏原特异性IgE水平。目前5至7岁的哮喘病例将由纽约长老会医院摩根士丹利儿童医院指定的委员会认证的儿科肺科医生进行确认。

DESCRIPTION (provided by applicant): The proposed study will determine whether early childhood exposures to phthalates are associated with the development of current asthma and proallergic immunoglobulin (Ig) E production at ages five to seven and whether current exposures to phthalates are associated with augmented airway inflammation and diminished lung function at ages five to seven. The research will confirm or refute recent epidemiologic findings of associations between phthalate exposures and childhood asthma, atopy and reduced lung function. This prior research is limited by incomplete exposure and outcome measures. However, results from a pilot undertaken for the proposed study also support the hypothesis that phthalate exposures are risk factors in the development of asthma. The proposed study will be conducted among a cohort of 400 children who reside in minority communities in New York City. These communities experience some of the highest childhood asthma rates in the world. Phthalate exposures are also widespread. The research will be performed within the ongoing longitudinal birth cohort study being conducted by the Columbia Center for Children's Environmental Health (CCCEH). The CCCEH is evaluating the contribution of prenatal and postnatal exposures in the development of asthma and other health outcomes. Children are followed from pregnancy through age seven years. The proposed research is cost effective in that many of the required exposure and outcome measurements are already being gathered within the CCCEH cohort. These include detailed history of respiratory and allergic symptoms, asthma treatment and emergency room visits; lung function testing at age six; allergen levels in house dust samples collected from pregnancy through age five; and measurement of allergic sensitization (total and specific IgE measured at ages two, three, and five years). The phthalates will be measured in stored urine samples collected from the mother during pregnancy and from children at ages three and five years and in newly collected indoor air and urine samples at ages five to seven. Also at age five to seven years, exhaled nitric oxide will be measured as an indicator of airway inflammation and total and allergen-specific IgE levels will be determined. The case ascertainment of current asthma at ages five to seven will be made by a designated board- certified pediatric pulmonologist at the Morgan Stanley Children's Hospital of New York Presbyterian Hospital. Hypotheses to be tested are: (1) that early childhood exposures to the phthalates, as measured by metabolite levels in urine samples collected during pregnancy and at ages three and five years, predict current asthma at ages five to seven and production of IgE antibodies at age seven; and (2) after correcting for early phthalate exposure, current exposure as measured by levels of the parent compounds in indoor air samples and metabolites in urine samples collected at ages five to seven years, will be associated inversely with lung function and positively with airway inflammation at ages five to seven years.