Long-term PM2.5 exposure is associated with asthma prevalence and exhaled nitric oxide levels in children

doi:10.1038/s41390-023-02977-5

. 2025 Jan;97(1):370-377.

doi: 10.1038/s41390-023-02977-5. Epub 2024 Jan 23.

Long-term PM_2.5 exposure is associated with asthma prevalence and exhaled nitric oxide levels in children

Yi-Giien Tsai^{1

2

3

4}, Chia-Pin Chio^#^{5

6}, Kuender D Yang^#⁷, Ching-Hsiung Lin^#^{8

9

10

11}, Yen-Po Yeh¹², Yu-Jun Chang¹³, Jien-Wen Chien^{1

4}, Shu-Li Wang^#¹⁴, Shau-Ku Huang^#^{15

16}, Chang-Chuan Chan^#¹⁷

Affiliations

¹ Department of Pediatrics, Changhua Christian Children's Hospital, Changhua, Taiwan, ROC.
² School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.
³ School of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC.
⁴ Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, ROC.
⁵ Department of Medical Research, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan, ROC.
⁶ Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan, ROC.
⁷ Department of Pediatrics, Mackay Memorial Hospital, and Department of Microbiology & Immunology, National Defense Medical Center, Taipei, Taiwan, ROC.
⁸ Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan, ROC.
⁹ Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan, ROC.
¹⁰ Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan, ROC.
¹¹ Department of Recreation and Holistic Wellness, MingDao University, Changhua, Taiwan, ROC.
¹² Changhua County Public Health Bureau, Changhua, Taiwan, ROC.
¹³ Epidemiology and Biostatistics Center, Changhua Christian Hospital, Changhua, Taiwan, ROC.
¹⁴ National Institute of Environmental Health Sciences, National Health Research Institutes, 35 Keyan Rd, Zhunan, Miaoli County, Miaoli, Taiwan, ROC. slwang@nhri.edu.tw.
¹⁵ National Institute of Environmental Health Sciences, National Health Research Institutes, 35 Keyan Rd, Zhunan, Miaoli County, Miaoli, Taiwan, ROC. skhuang@nhri.edu.tw.
¹⁶ Johns Hopkins Asthma and Allergy Center, School of Medicine, Johns Hopkins University, Baltimore, MD, USA. skhuang@nhri.edu.tw.
¹⁷ Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan, ROC. ccchan@ntu.edu.tw.

^# Contributed equally.

PMID: 38263452
DOI: 10.1038/s41390-023-02977-5

Long-term PM_2.5 exposure is associated with asthma prevalence and exhaled nitric oxide levels in children

Yi-Giien Tsai et al. Pediatr Res. 2025 Jan.

. 2025 Jan;97(1):370-377.

doi: 10.1038/s41390-023-02977-5. Epub 2024 Jan 23.

Authors

Affiliations

¹ Department of Pediatrics, Changhua Christian Children's Hospital, Changhua, Taiwan, ROC.
² School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.
³ School of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC.
⁴ Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, ROC.
⁵ Department of Medical Research, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan, ROC.
⁶ Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan, ROC.
⁷ Department of Pediatrics, Mackay Memorial Hospital, and Department of Microbiology & Immunology, National Defense Medical Center, Taipei, Taiwan, ROC.
⁸ Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan, ROC.
⁹ Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan, ROC.
¹⁰ Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan, ROC.
¹¹ Department of Recreation and Holistic Wellness, MingDao University, Changhua, Taiwan, ROC.
¹² Changhua County Public Health Bureau, Changhua, Taiwan, ROC.
¹³ Epidemiology and Biostatistics Center, Changhua Christian Hospital, Changhua, Taiwan, ROC.
¹⁴ National Institute of Environmental Health Sciences, National Health Research Institutes, 35 Keyan Rd, Zhunan, Miaoli County, Miaoli, Taiwan, ROC. slwang@nhri.edu.tw.
¹⁵ National Institute of Environmental Health Sciences, National Health Research Institutes, 35 Keyan Rd, Zhunan, Miaoli County, Miaoli, Taiwan, ROC. skhuang@nhri.edu.tw.
¹⁶ Johns Hopkins Asthma and Allergy Center, School of Medicine, Johns Hopkins University, Baltimore, MD, USA. skhuang@nhri.edu.tw.
¹⁷ Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan, ROC. ccchan@ntu.edu.tw.

^# Contributed equally.

PMID: 38263452
DOI: 10.1038/s41390-023-02977-5

Abstract

Background: Exhaled nitric oxide concentration (FENO) is a marker of airway inflammation. This study aimed to evaluate the association of air pollution exposure with FENO levels and asthma prevalence with respiratory symptoms in school children.

Methods: We analyzed 4736 school children who reside in six townships near industrial areas in central Taiwan. We evaluated asthmatic symptoms, FENO, and conducted the environmental questionnaire. The personal exposure of PM_2.5, NO, and SO₂ was estimated using land-use regression models data on children's school and home addresses.

Results: Annual exposure to PM_2.5 was associated with increased odds of physician-diagnosed asthma (OR = 1.595), exercise-induced wheezing (OR = 1.726), itchy eyes (OR = 1.417), and current nasal problems (OR = 1.334) (P < 0.05). FENO levels in the absence of infection were positively correlated with age, previous wheezing, allergic rhinitis, atopic eczema, near the road, and for children with high exposure to PM_2.5 (P < 0.05). An increase of 1 μg/m³ PM_2.5 exposure was significantly associated with a 1.0% increase in FENO levels for children after adjusting for potential confounding variables, including exposures to NO and SO₂.

Conclusions: Long-term exposures to PM_2.5 posed a significant risk of asthma prevalence and airway inflammation in a community-based population of children.

Impact: Annual exposure to PM_2.5 was associated with increased odds of physician-diagnosed asthma and nasal problems and itchy eyes. Long-term exposures to PM2.5 were significantly associated with FENO levels after adjusting for potential confounding variables. This is first study to assess the association between FENO levels and long-term air pollution exposures in children near coal-based power plants. An increase of 1 μg/m³ annual PM_2.5 exposure was significantly associated with a 1.0% increase in FENO levels. Long-term exposures to PM2.5 posed a significant risk of asthma prevalence and airway inflammation in a community-based population of children.

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Conflict of interest statement

Competing interests: The authors declare no competing interests.

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References

1. Ma, X., Longley, I., Gao, J. & Salmond, J. Assessing school children’s exposure to air pollution during the daily commute—a systematic review. Sci. Total Environ. 737, 140389 (2020). - PubMed - DOI
1. Murrison, L. B., Brandt, E. B., Myers, J. B. & Hershey, G. K. K. Environmental exposures and mechanisms in allergy and asthma development. J. Clin. Investig. 129, 1504–1515 (2019). - PubMed - PMC - DOI
1. Pawankar, R. et al. Asia Pacific Association of Allergy Asthma and Clinical Immunology White Paper 2020 on climate change, air pollution, and biodiversity in Asia-Pacific and impact on allergic diseases. Asia Pac. Allergy 10, e11 (2020). - PubMed - PMC - DOI
1. Poole, J. A. et al. Impact of weather and climate change with indoor and outdoor air quality in asthma: a work group report of the AAAAI Environmental Exposure and Respiratory Health Committee. J. Allergy Clin. Immunol. 143, 1702–1710 (2019). - PubMed - PMC - DOI
1. Houdouin, V. & Dubus, J. C. What is the impact of outdoor pollution on children’s asthma? Arch. Pediatr. 26, 487–491 (2019). - PubMed - DOI

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[1] Ma, X., Longley, I., Gao, J. & Salmond, J. Assessing school children’s exposure to air pollution during the daily commute—a systematic review. Sci. Total Environ. 737, 140389 (2020). - PubMed - DOI

[2] Ma, X., Longley, I., Gao, J. & Salmond, J. Assessing school children’s exposure to air pollution during the daily commute—a systematic review. Sci. Total Environ. 737, 140389 (2020). - PubMed - DOI

[3] Murrison, L. B., Brandt, E. B., Myers, J. B. & Hershey, G. K. K. Environmental exposures and mechanisms in allergy and asthma development. J. Clin. Investig. 129, 1504–1515 (2019). - PubMed - PMC - DOI

[4] Murrison, L. B., Brandt, E. B., Myers, J. B. & Hershey, G. K. K. Environmental exposures and mechanisms in allergy and asthma development. J. Clin. Investig. 129, 1504–1515 (2019). - PubMed - PMC - DOI

[5] Pawankar, R. et al. Asia Pacific Association of Allergy Asthma and Clinical Immunology White Paper 2020 on climate change, air pollution, and biodiversity in Asia-Pacific and impact on allergic diseases. Asia Pac. Allergy 10, e11 (2020). - PubMed - PMC - DOI

[6] Pawankar, R. et al. Asia Pacific Association of Allergy Asthma and Clinical Immunology White Paper 2020 on climate change, air pollution, and biodiversity in Asia-Pacific and impact on allergic diseases. Asia Pac. Allergy 10, e11 (2020). - PubMed - PMC - DOI

[7] Poole, J. A. et al. Impact of weather and climate change with indoor and outdoor air quality in asthma: a work group report of the AAAAI Environmental Exposure and Respiratory Health Committee. J. Allergy Clin. Immunol. 143, 1702–1710 (2019). - PubMed - PMC - DOI

[8] Poole, J. A. et al. Impact of weather and climate change with indoor and outdoor air quality in asthma: a work group report of the AAAAI Environmental Exposure and Respiratory Health Committee. J. Allergy Clin. Immunol. 143, 1702–1710 (2019). - PubMed - PMC - DOI

[9] Houdouin, V. & Dubus, J. C. What is the impact of outdoor pollution on children’s asthma? Arch. Pediatr. 26, 487–491 (2019). - PubMed - DOI

[10] Houdouin, V. & Dubus, J. C. What is the impact of outdoor pollution on children’s asthma? Arch. Pediatr. 26, 487–491 (2019). - PubMed - DOI

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Long-term PM_2.5 exposure is associated with asthma prevalence and exhaled nitric oxide levels in children

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Long-term PM_2.5 exposure is associated with asthma prevalence and exhaled nitric oxide levels in children

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