Indoor air pollution and asthma in children

Abstract

The purpose of this article is to review indoor air pollution factors that can modify asthma severity, particularly in inner-city environments. While there is a large literature linking ambient air pollution and asthma morbidity, less is known about the impact of indoor air pollution on asthma. Concentrating on the indoor environments is particularly important for children, since they can spend as much as 90% of their time indoors. This review focuses on studies conducted by the Johns Hopkins Center for Childhood Asthma in the Urban Environment as well as other relevant epidemiologic studies. Analysis of exposure outcome relationships in the published literature demonstrates the importance of evaluating indoor home environmental air pollution sources as risk factors for asthma morbidity. Important indoor air pollution determinants of asthma morbidity in urban environments include particulate matter (particularly the coarse fraction), nitrogen dioxide, and airborne mouse allergen exposure. Avoidance of harmful environmental exposures is a key component of national and international guideline recommendations for management of asthma. This literature suggests that modifying the indoor environment to reduce particulate matter, NO(2), and mouse allergen may be an important asthma management strategy. More research documenting effectiveness of interventions to reduce those exposures and improve asthma outcomes is needed.

Figure 1.

Comparison of particulate matter (PM) concentrations simultaneously measured indoors, immediately outdoors, and at a central monitoring site.

Figure 2.

Distributions of indoor PM in the child's bedroom.

Figure 3.

Indoor PM concentrations, asthma symptoms, and rescue medication use: multivariate models (coarse module adjusted for age, sex, race, parent education level, season, indoor fine PM, ambient fine PM, ambient coarse PM; fine module adjusted for age, sex, race, parent education level, season, indoor coarse PM, ambient coarse PM, ambient fine PM).

Figure 4.

Risk of asthma symptoms per 20-ppb increase in NO₂ exposure, adjusted for PM_2.5; second hand smoke; distance from the curb; type of street in front of house; season of sampling; age, sex, and race of child; and mother's education level.

Figure 5.

Recent asthma symptoms and rescue medication use among mouse-sensitized, highly exposed children. Adjusted for age, sex, atopy, cockroach sensitization and exposure, public health insurance, and study visit.

Figure 6.

Asthma health care use among mouse-sensitized, highly exposed children adjusted for age, sex, atopy, cockroach sensitization and exposure, public health insurance, and study visit.