Ambient air pollution and variation in multiple domains of asthma morbidity among Peruvian children

and the GASP Study Investigators

Research output: Contribution to journalArticle

Abstract

Rationale: A large portion of asthma morbidity occurs in low- and middle-income countries, and Peru suffers particularly high asthma prevalence. Ambient air exposures are also high, and likely play a role. Most studies of environmental exposures focus on understanding contributors to health care utilization or mortality risk; however, less severe outcomes may still impact quality of life (QOL). Objectives: To study the association between multiple pollutants and several asthma domains in Peruvian children. Methods: A total of 484 children aged 9–19 years with asthma were followed for 6–9 months, and evaluated for asthma control, asthma-related QOL, missed school days, and health care utilization. We used geographically distributed monitors to estimate air pollutant concentrations and multivariable generalized linear mixed models to model asthma outcomes as a function of pollutants. Results: A total of 67% of children had moderate to severe persistent asthma. In multipollutant models, higher particulate matter less than 2.5 mm in aerodynamic diameter (PM 2.5 ), black carbon, and nitrogen dioxide concentrations were independently associated with worse asthma control. For each interquartile range increase in PM 2.5 or nitrogen dioxide concentration, there was a 59% or 34% higher odds of uncontrolled asthma, respectively. If the proportion of PM 2.5 that was black carbon increased, there were increased odds of uncontrolled asthma. Similarly, pollutants were independently associated with worse asthma-related QOL, and PM exposure was associated with increased risk of health care utilization. Conclusions: Our study highlights the importance of pollutant exposures on multiple domains of asthma morbidity among Peruvian children, including not only acute exacerbations, but also on general asthma burden, such as worse asthma symptom control and QOL.

Original languageEnglish (US)
Pages (from-to)348-355
Number of pages8
JournalAnnals of the American Thoracic Society
Volume16
Issue number3
DOIs
StatePublished - Mar 1 2019

Fingerprint

Air Pollution
Asthma
Morbidity
Patient Acceptance of Health Care
Quality of Life
Nitrogen Dioxide
Soot
Air Pollutants
Peru
School Health Services
Particulate Matter
Environmental Exposure
Carbon Dioxide
Linear Models

Keywords

  • Air pollution
  • Asthma
  • Children
  • Nitrogen dioxide
  • Particulate matter

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Ambient air pollution and variation in multiple domains of asthma morbidity among Peruvian children. / and the GASP Study Investigators.

In: Annals of the American Thoracic Society, Vol. 16, No. 3, 01.03.2019, p. 348-355.

Research output: Contribution to journalArticle

@article{c64a37048f3e4986aba734b33ce25319,
title = "Ambient air pollution and variation in multiple domains of asthma morbidity among Peruvian children",
abstract = "Rationale: A large portion of asthma morbidity occurs in low- and middle-income countries, and Peru suffers particularly high asthma prevalence. Ambient air exposures are also high, and likely play a role. Most studies of environmental exposures focus on understanding contributors to health care utilization or mortality risk; however, less severe outcomes may still impact quality of life (QOL). Objectives: To study the association between multiple pollutants and several asthma domains in Peruvian children. Methods: A total of 484 children aged 9–19 years with asthma were followed for 6–9 months, and evaluated for asthma control, asthma-related QOL, missed school days, and health care utilization. We used geographically distributed monitors to estimate air pollutant concentrations and multivariable generalized linear mixed models to model asthma outcomes as a function of pollutants. Results: A total of 67{\%} of children had moderate to severe persistent asthma. In multipollutant models, higher particulate matter less than 2.5 mm in aerodynamic diameter (PM 2.5 ), black carbon, and nitrogen dioxide concentrations were independently associated with worse asthma control. For each interquartile range increase in PM 2.5 or nitrogen dioxide concentration, there was a 59{\%} or 34{\%} higher odds of uncontrolled asthma, respectively. If the proportion of PM 2.5 that was black carbon increased, there were increased odds of uncontrolled asthma. Similarly, pollutants were independently associated with worse asthma-related QOL, and PM exposure was associated with increased risk of health care utilization. Conclusions: Our study highlights the importance of pollutant exposures on multiple domains of asthma morbidity among Peruvian children, including not only acute exacerbations, but also on general asthma burden, such as worse asthma symptom control and QOL.",
keywords = "Air pollution, Asthma, Children, Nitrogen dioxide, Particulate matter",
author = "{and the GASP Study Investigators} and Nadia Hansel and Romero, {Karina M.} and Suzanne Pollard and Sonali Bose and Kevin Psoter and Underhill, {Lindsay J.} and Caroline Johnson and D'Ann Williams and Curriero, {Frank C} and Breysse, {Patrick N} and Koehler, {Kirsten A} and William Checkley",
year = "2019",
month = "3",
day = "1",
doi = "10.1513/AnnalsATS.201807-448OC",
language = "English (US)",
volume = "16",
pages = "348--355",
journal = "Annals of the American Thoracic Society",
issn = "2325-6621",
publisher = "American Thoracic Society",
number = "3",

}

TY - JOUR

T1 - Ambient air pollution and variation in multiple domains of asthma morbidity among Peruvian children

AU - and the GASP Study Investigators

AU - Hansel, Nadia

AU - Romero, Karina M.

AU - Pollard, Suzanne

AU - Bose, Sonali

AU - Psoter, Kevin

AU - Underhill, Lindsay J.

AU - Johnson, Caroline

AU - Williams, D'Ann

AU - Curriero, Frank C

AU - Breysse, Patrick N

AU - Koehler, Kirsten A

AU - Checkley, William

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Rationale: A large portion of asthma morbidity occurs in low- and middle-income countries, and Peru suffers particularly high asthma prevalence. Ambient air exposures are also high, and likely play a role. Most studies of environmental exposures focus on understanding contributors to health care utilization or mortality risk; however, less severe outcomes may still impact quality of life (QOL). Objectives: To study the association between multiple pollutants and several asthma domains in Peruvian children. Methods: A total of 484 children aged 9–19 years with asthma were followed for 6–9 months, and evaluated for asthma control, asthma-related QOL, missed school days, and health care utilization. We used geographically distributed monitors to estimate air pollutant concentrations and multivariable generalized linear mixed models to model asthma outcomes as a function of pollutants. Results: A total of 67% of children had moderate to severe persistent asthma. In multipollutant models, higher particulate matter less than 2.5 mm in aerodynamic diameter (PM 2.5 ), black carbon, and nitrogen dioxide concentrations were independently associated with worse asthma control. For each interquartile range increase in PM 2.5 or nitrogen dioxide concentration, there was a 59% or 34% higher odds of uncontrolled asthma, respectively. If the proportion of PM 2.5 that was black carbon increased, there were increased odds of uncontrolled asthma. Similarly, pollutants were independently associated with worse asthma-related QOL, and PM exposure was associated with increased risk of health care utilization. Conclusions: Our study highlights the importance of pollutant exposures on multiple domains of asthma morbidity among Peruvian children, including not only acute exacerbations, but also on general asthma burden, such as worse asthma symptom control and QOL.

AB - Rationale: A large portion of asthma morbidity occurs in low- and middle-income countries, and Peru suffers particularly high asthma prevalence. Ambient air exposures are also high, and likely play a role. Most studies of environmental exposures focus on understanding contributors to health care utilization or mortality risk; however, less severe outcomes may still impact quality of life (QOL). Objectives: To study the association between multiple pollutants and several asthma domains in Peruvian children. Methods: A total of 484 children aged 9–19 years with asthma were followed for 6–9 months, and evaluated for asthma control, asthma-related QOL, missed school days, and health care utilization. We used geographically distributed monitors to estimate air pollutant concentrations and multivariable generalized linear mixed models to model asthma outcomes as a function of pollutants. Results: A total of 67% of children had moderate to severe persistent asthma. In multipollutant models, higher particulate matter less than 2.5 mm in aerodynamic diameter (PM 2.5 ), black carbon, and nitrogen dioxide concentrations were independently associated with worse asthma control. For each interquartile range increase in PM 2.5 or nitrogen dioxide concentration, there was a 59% or 34% higher odds of uncontrolled asthma, respectively. If the proportion of PM 2.5 that was black carbon increased, there were increased odds of uncontrolled asthma. Similarly, pollutants were independently associated with worse asthma-related QOL, and PM exposure was associated with increased risk of health care utilization. Conclusions: Our study highlights the importance of pollutant exposures on multiple domains of asthma morbidity among Peruvian children, including not only acute exacerbations, but also on general asthma burden, such as worse asthma symptom control and QOL.

KW - Air pollution

KW - Asthma

KW - Children

KW - Nitrogen dioxide

KW - Particulate matter

UR - http://www.scopus.com/inward/record.url?scp=85062207281&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85062207281&partnerID=8YFLogxK

U2 - 10.1513/AnnalsATS.201807-448OC

DO - 10.1513/AnnalsATS.201807-448OC

M3 - Article

C2 - 30365919

AN - SCOPUS:85062207281

VL - 16

SP - 348

EP - 355

JO - Annals of the American Thoracic Society

JF - Annals of the American Thoracic Society

SN - 2325-6621

IS - 3

ER -