Journal
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY
Volume 146, Issue 4, Pages 813-+Publisher
MOSBY-ELSEVIER
DOI: 10.1016/j.jaci.2020.03.003
Keywords
Asthma; obesity; body mass index; BMI; inner-city; urban; school; nitrogen dioxide; NO2; children; environment; exposure; indoor; pollutant; air
Categories
Funding
- National Institutes of Health [R01 AI 073964, U01 AI 110397, K24 AI 106822, K23 AI 123517, R01 ES 030100, R01 AI 144119, K23 AI 104780]
- Allergy and Asthma Awareness Initiative, Inc.
- Harvard Catalyst j The Harvard Clinical and Translational Science Center (National Center for Research Resources)
- Harvard Catalyst j The Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, National Institutes of Health) [UL1 TR001102]
- Harvard University
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Background: Sparse data address the effects of nitrogen dioxide (NO2) exposure in inner-city schools on obese students with asthma. Objective: We sought to evaluate relationships between classroom NO2 exposure and asthma symptoms and morbidity by body mass index (BMI) category. Methods: The School Inner-City Asthma Study enrolled students aged 4 to 13 years with asthma from 37 inner-city schools. Students had baseline determination of BMI percentile. Asthma symptoms, morbidity, pulmonary inflammation, and lung function were monitored throughout the subsequent academic year. Classroom NO2 data, linked to enrolled students, were collected twice per year. We determined the relationship between classroom NO2 levels and asthma outcomes by BMI stratification. Results: A total of 271 predominantly black (35%) or Hispanic students (35%) were included in analyses. Fifty percent were normal weight (5-84th BMI percentile), 15% overweight (>= 85-94th BMI percentile), and 35% obese (>95th BMI percentile). For each 10-parts per billion increase in NO2, obese students had a significant increase in the odds of having an asthma symptom day (odds ratio [OR], 1.86; 95% CI, 1.15-3.02) and in days caregiver changed plans (OR, 4.24; 95% CI, 2.33-7.70), which was significantly different than normal weight students who exhibited no relationship between NO2 exposure and symptom days (OR, 0.90; 95% CI, 0.57-1.42; pairwise interaction P > .03) and change in caregiver plans (OR, 1.37; 95% CI, 0.67-2.82; pairwise interaction P = .02). Relationships between NO2 levels and lung function and fractional exhaled nitric oxide did not differ by BMI category. If we applied a conservative Holm-Bonferroni correction for 16 comparisons (obese vs normal weight and overweight vs normal weight for 8 outcomes), these findings would not meet statistical significance (all P >.003). Conclusions: Obese BMI status appears to increase susceptibility to classroom NO2 exposure effects on asthma symptoms in inner-city children. Environmental interventions targeting indoor school NO2 levels may improve asthma health for obese children. Although our findings would not remain statistically significant after adjustment for multiple comparisons, the large effect sizes warrant future study of the interaction of obesity and pollution in pediatric asthma.
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