Association of low-level ozone and fine particles with respiratory symptoms in children with asthma
Abstract
CONTEXT: Exposure to ozone and particulate matter of 2.5 microm or less (PM2.5) in air at levels above current US Environmental Protection Agency (EPA) standards is a risk factor for respiratory symptoms in children with asthma. OBJECTIVE: To examine simultaneous effects of ozone and PM2.5 at levels below EPA standards on daily respiratory symptoms and rescue medication use among children with asthma. DESIGN, SETTING, AND PARTICIPANTS: Daily respiratory symptoms and medication use were examined prospectively for 271 children younger than 12 years with physician-diagnosed, active asthma residing in southern New England. Exposure to ambient concentrations of ozone and PM2.5 from April 1 through September 30, 2001, was assessed using ozone (peak 1-hour and 8-hour) and 24-hour PM2.5. Logistic regression analyses using generalized estimating equations were performed separately for maintenance medication users (n = 130) and nonusers (n = 141). Associations between pollutants (adjusted for temperature, controlling for same- and previous-day levels) and respiratory symptoms and use of rescue medication were evaluated. MAIN OUTCOME MEASURES: Respiratory symptoms and rescue medication use recorded on calendars by subjects' mothers. RESULTS: Mean (SD) levels were 59 (19) ppb (1-hour average) and 51 (16) ppb (8-hour average) for ozone and 13 (8) microg/m3 for PM2.5. In copollutant models, ozone level but not PM2.5 was significantly associated with respiratory symptoms and rescue medication use among children using maintenance medication; a 50-ppb increase in 1-hour ozone was associated with increased likelihood of wheeze (by 35%) and chest tightness (by 47%). The highest levels of ozone (1-hour or 8-hour averages) were associated with increased shortness of breath and rescue medication use. No significant, exposure-dependent associations were observed for any outcome by any pollutant among children who did not use maintenance medication. CONCLUSION: Asthmatic children using maintenance medication are particularly vulnerable to ozone, controlling for exposure to fine particles, at levels below EPA standards.
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O3 levels below U.S. EPA regulations have been associated with increased frequency of respiratory symptoms in children with asthma.
“O3 levels below U.S. EPA regulations have been associated with increased frequency of respiratory symptoms in children with asthma (Gent et al. 2003).”
From The Exposure–Response Curve for Ozone and Risk of Mortality and the Adequacy of Current Ozone Regulations (2006) · cites this paper as Gent et al. 2003
Cites
Longitudinal data analysis using generalized linear models
LIANG, K.-Y., & ZEGER, S. L. (1986) · Biometrika · doi:10.1093/biomet/73.1.13 · Cited by 18,550 · see citing works
Logistic Regression Using the SAS System : Theory and Application
Allison, P. D. (1999) · Cited by 2,087 · see citing works
Friedman, M. S. (2001) · JAMA · doi:10.1001/jama.285.7.897 · Cited by 588 · see citing works
Frederiksen, B., Koch, C., & Høiby, N. (1997) · Pediatric Pulmonology · doi:10.1002/(sici)1099-0496(199705)23:5 · Cited by 471 · see citing works
Effects of Air Pollution on the Respiratory Health of Asthmatic Children Living in Mexico City
Romieu, I., Meneses, F., Ruiz‐Velasco, S., Sienra, J. J., Huerta, J., White, M. C., & Etzel, R. A. (1996) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.154.2.8756798 · Cited by 321 · see citing works
Air Pollution and Exacerbation of Asthma in African-American Children in Los Angeles
Ostro, B. D., Lipsett, M., Mann, J. K., Braxton-Owens, H., & White, A. M. (2001) · Epidemiology · doi:10.1097/00001648-200103000-00012 · Cited by 254 · see citing works
Gold, D. R., Damokosh, A. I., Pope, C. A., Dockery, D. W., McDonnell, W. F., Serrano, P., Retama, A., & Castillejos, M. (1999) · Epidemiology · doi:10.1097/00001648-199901000-00004 · Cited by 234 · see citing works
Belanger, K. D. (2003) · American Journal of Epidemiology · doi:10.1093/aje/kwg148 · Cited by 232 · see citing works
Effects of Ambient Ozone on Respiratory Function in Active, Normal Children
Spektor, D. M., Lippmann, M., Lioy, P. J., et al. (1988) · American Review of Respiratory Disease · doi:10.1164/ajrccm/137.2.313 · Cited by 179 · see citing works
Summertime Haze Air Pollution and Children With Asthma
Thurston, G. D., Lippmann, M., Scott, M., & Fine, J. M. (1997) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.155.2.9032209 · Cited by 164 · see citing works
Gent, J. F., Ren, P., Belanger, K. D., Triche, E. W., Bracken, M. B., Holford, T. R., & Leaderer, B. P. (2002) · Environmental Health Perspectives · doi:10.1289/ehp.021100781 · Cited by 161 · see citing works
Self-citationAcute Effects of Summer Air Pollution on Respiratory Health of Asthmatic Children
Gielen, M. H., van der Zee, S. C., Wijnen, J. H. V., van Steen, C. J., & Brunekreef, B. (1997) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.155.6.9196122 · Cited by 145 · see citing works
Delfino, R. J., Zeiger, R. S., Seltzer, J. M., & Street, D. H. (1998) · Environmental Health Perspectives · doi:10.1289/ehp.98106751 · Cited by 142 · see citing works
Kehrl, H., Peden, D. B., Ball, B. A., Folinsbee, L. J., & Horstman, D. H. (1999) · Journal of Allergy and Clinical Immunology · doi:10.1016/s0091-6749(99)70013-8 · Cited by 112 · see citing works
Romieu, I., Meneses, F., Ruiz‐Velasco, S., et al. (1997) · Archives of Environmental Health An International Journal · doi:10.1080/00039899709602213 · Cited by 95 · see citing works
Peters, A., Dockery, D. W., Heinrich, J., et al. (1997) · Environmental Health Perspectives · doi:10.1289/ehp.97105430 · Cited by 70 · see citing works
The Effect of Ozone on Inner-City Children with Asthma
MORTIMER, K. M., Tager, I. B., Dockery, D. W., Neas, L., & Redline, S. S. (2000) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.162.5.9908113 · Cited by 66 · see citing works
Air Pollution and Asthma Exacerbations Among African-American Children in Los Angeles
Ostro, B. D., Lipsett, M. J., Mann, J. K., et al. (1995) · Inhalation Toxicology · doi:10.3109/08958379509014475 · Cited by 63 · see citing works
Asthma and respiratory irritants (ozone).
Silverman, F. (1979) · Environmental Health Perspectives · doi:10.1289/ehp.7929131 · Cited by 48 · see citing works
Hanania, N. A., Tarlo, S. M., Silverman, F., et al. (1998) · CHEST Journal · doi:10.1378/chest.114.3.752 · Cited by 23 · see citing works
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Di, Q., Kloog, I., Koutrakis, P., Lyapustin, A., Wang, Y., & Schwartz, J. (2016) · Environmental Science & Technology · doi:10.1021/acs.est.5b06121 · Cited by 510 · see citing works
Bell, M. L., Peng, R. D., & Dominici, F. (2006) · Environmental Health Perspectives · doi:10.1289/ehp.8816 · Cited by 481 · see citing works
“O3 levels below U.S. EPA regulations have been associated with increased frequency of respiratory symptoms in children with asthma (Gent et al. 2003).”
Strickland, M. J., Darrow, L. A., Klein, M., Flanders, W. D., Sarnat, J. A., Waller, L. A., Sarnat, S. E., Mulholland, J. A., & Tolbert, P. E. (2010) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200908-1201oc · Cited by 349 · see citing works
Long-Term Exposure to Ozone and Cause-Specific Mortality Risk in the United States
Lim, C. C., Hayes, R. B., Ahn, J., Shao, Y., Silverman, D. T., Jones, R. R., Garcia, C., Bell, M. L., & Thurston, G. D. (2019) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201806-1161oc · Cited by 237 · see citing works
Chronic exposure to ambient ozone and asthma hospital admissions among children
Lin, S., Liu, X., Le, L. H., & Hwang, S.-A. (2008) · Environmental Health Perspectives · doi:10.1289/ehp.11184 · Cited by 130 · see citing works
Climate change, air pollution, pollen allergy and extreme atmospheric events
D’Amato, G., & D’Amato, M. (2023) · Current Opinion in Pediatrics · doi:10.1097/mop.0000000000001237 · Cited by 83 · see citing works
- Authors
- Gent, J. F.
- Affiliations
- Yale University (US)
- Corresponding author
- Gent, Janneane F.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2003-10-08
- Volume
- 290
- Issue
- 14
- Pages
- 1859
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2121487574
- Cited by
- 477
- References
- 20
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 12 · 2023: 17 · 2022: 15 · 2021: 18 · 2020: 19 · 2019: 23 · 2018: 9 · 2017: 18 · 2016: 22 · 2015: 15 · 2014: 17 · 2013: 17 · 2012: 29
- FWCI
- 19.53
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Environmental Health Sciences (ES 11013, ES-01247, R01ES011013, ES-05410, R01ES007456, ES/07456, P30ES001247)
- Topics
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Air Quality and Health Impacts
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Indoor Air Quality and Microbial Exposure
- Keywords
- low-level ozone, PM2.5, childhood asthma, respiratory symptoms, rescue medication use, wheezing, chest tightness, dyspnea, maintenance medication, air pollution exposure, EPA air quality standards
- MeSH terms
- Air Pollutants, Air Pollution, Asthma, Child, Child, Preschool, Connecticut, Dyspnea, Female, Humans, Male, Massachusetts, Ozone, Particle Size, Respiratory Sounds, Severity of Illness Index, Cohort Studies, Anti-Asthmatic Agents
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