Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Respiratory symptoms and peak expiratory flow in children with asthma in relation to volatile organic compounds in exhaled breath and ambient air

Abstract

Indoor volatile organic compounds (VOCs) have been associated with asthma, but there is little epidemiologic work on ambient exposures, and no data on relationships between respiratory health and exhaled breath VOCs, which is a biomarker of VOC exposure. We recruited 26 Hispanic children with mild asthma in a Los Angeles community with high VOC levels near major freeways and trucking routes. Two dropped out, three had invalid peak expiratory flow (PEF) or breath VOC data, leaving 21. Children filled out symptom diaries and performed PEF maneuvers daily, November 1999–January 2000. We aimed to collect breath VOC samples on asthma episode and baseline symptom-free days, but six subjects only gave samples on symptom-free days. We analyzed 106 breath samples by GC–MS. Eight VOCs were quantifiable in >75% of breath samples (benzene, methylene chloride, styrene, tetrachloroethylene, toluene, m,p-xylene, o-xylene, and p-dichlorobenzene). Generalized estimating equation and mixed linear regression models for VOC exposure–response relationships controlled for temperature and respiratory infections. We found marginally positive associations between bothersome or more severe asthma symptoms and same day breath concentrations of benzene [odds ratio (OR) 2.03, 95% confidence interval (CI) 0.80, 5.11] but not other breath VOCs. Ambient petroleum-related VOCs measured on the same person-days as breath VOCs showed notably stronger associations with symptoms, including toluene, m,p-xylene, o-xylene, and benzene (OR 5.93, 95% CI 1.64, 21.4). On breath sample days, symptoms were also associated with 1-h ambient NO2, OR 8.13 (1.52, 43.4), and SO2, OR 2.36 (1.16, 4.81). Consistent inverse relationships were found between evening PEF and the same ambient VOCs, NO2, and SO2. There were no associations with O3. Given the high traffic density of the region, stronger associations for ambient than for breath VOCs suggest that ambient VOC measurements were better markers for daily exposure to combustion-related compounds thought to be causally related to acute asthma. Alternatively, the low sample size of symptom responses (15–21 responses per 108 breath samples) may have led to the nonsignificant results for breath VOCs.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

Figure 1
Figure 2

References

  • American Thoracic Society Workshop. Immunobiology of asthma and rhinitis. Pathogenic factors and therapeutic options. Am J Respir Crit Care Med 1999: 160 (5 Part 1): 1778–1787.

  • Bernstein I.L., Chan-Yeung M., Malo J.-L., and Bernstein D.I . Asthma in the Workplace. Marcel Dekker, New York, NY, 1999.

    Google Scholar 

  • Buchdahl R., Willems C.D., Vander M., and Babiker A . Associations between ambient ozone, hydrocarbons, and childhood wheezy episodes: a prospective observational study in south east London. Occup Environ Med 2000: 57: 86–93.

    Article  CAS  Google Scholar 

  • Chan-Yeung M., Chang J.H., Manfreda J., Ferguson A., and Becker A . Changes in peak flow, symptom score, and the use of medications during acute exacerbations of asthma. Am J Respir Crit Care Med 1996: 154: 889–893.

    Article  CAS  Google Scholar 

  • Delfino R.J. Epidemiological evidence for asthma and exposure to air toxics: linkages between occupational, indoor, and community air pollution research. Environ Health Perspect 2002: 110(Suppl. 4): 573–589.

    Article  CAS  Google Scholar 

  • Delfino R.J., Coate B., Zeiger R.S., Seltzer J.M., Street D.H., and Koutrakis P . Daily asthma severity in relation to personal ozone exposure and outdoor fungal spores. Am J Respir Crit Care Med 1996: 154: 633–641.

    Article  CAS  Google Scholar 

  • Delfino R.J., Gong Jr. H., Linn W.S., Hu Y., and Pellizzari E.D. Asthma symptoms in Hispanic children and daily ambient exposures to toxic and criteria air pollutants. Environ Health Perspect 2003: 111: 647–656.

    Article  CAS  Google Scholar 

  • Delfino R.J., Zeiger R.S., Seltzer J.M., et al. The effect of outdoor fungal spore concentrations on asthma severity. Environ Health Perspect 1997: 105: 622–635.

    Article  CAS  Google Scholar 

  • Delfino R.J., Zeiger R.S., Seltzer J.M., and Street D.H . Symptoms in pediatric asthmatics and air pollution: differences in effects by symptom severity, anti-inflammatory medication use, and particulate averaging time. Environ Health Perspect 1998: 106: 751–761.

    Article  CAS  Google Scholar 

  • Delfino R.J., Zeiger R.S., Seltzer J.M., Street D.H., and McLaren C . Effects of hourly particulate air pollution on asthma symptoms: interaction with use of anti-inflammatory medications. Environ Health Perspect 2002: 110: A607–A617.

    CAS  Google Scholar 

  • Diez U., Kroessner T., Rehwagen M. et al. Effects of indoor painting and smoking on airway symptoms in atopy risk children in the first year of life results of the LARS-study. Leipzig Allergy High-Risk Children Study. Int J Hyg Environ Health 2000: 203: 23–28.

    Article  CAS  Google Scholar 

  • Enright P.L., Sherrill D.L., and Lebowitz M.D . Ambulatory monitoring of peak expiratory flow. Reproducibility and quality control. Chest 1995: 107: 657–661.

    Article  CAS  Google Scholar 

  • Gordon S.M., Kenny D.V., and Kelly T.J . Continuous real-time breath analysis for the measurement of half-lives of expired volatile organic compounds. J Expo Anal Environ Epidemiol 1992: Suppl. 1: 41–54.

  • Hagen J.A., Nafstad P., Skrondal A., Bjorkly S., and Magnus P . Associations between outdoor air pollutants and hospitalization for respiratory diseases. Epidemiology 2000: 11: 136–140.

    Article  CAS  Google Scholar 

  • Hankinson J.L., Odencrantz J.R., and Fedan K.B . Spirometric reference values from a sample of the general U.S. population. Am J Respir Crit Care Med 1999: 159: 179–187.

    Article  CAS  Google Scholar 

  • Jennrich R.I., and Schluchter M.D . Unbalanced repeated-measures models with structured covariance matrices. Biometrics 1986: 42: 805–820.

    Article  CAS  Google Scholar 

  • Koren H.S., Graham D.E., and Devlin R.B . Exposure of humans to a volatile organic mixture. III. Inflammatory response. Arch Environ Health 1992: 47: 39.

    Article  CAS  Google Scholar 

  • Leikauf G.D., Kline S., Albert R.E., Baxter C.S., Bernstein D.I., and Buncher C.R . Evaluation of a possible association of urban air toxics and asthma. Environ Health Perspect 1995: 103 (Suppl 6): 253–271.

    Article  CAS  Google Scholar 

  • Levine M., and Ensom M.H.H . Post hoc power analysis: an idea whose time has passed? Pharmacotherapy 2001: 21: 405–409.

    Article  CAS  Google Scholar 

  • Liang K.-Y., and Zeger S.L . Longitudinal data analysis using generalized linear models. Biometrika 1986: 73: 13–22.

    Article  Google Scholar 

  • Lindstrom M.J., and Bates D.M . Newton–Rhaphson and EM algorithms for linear mixed-effects models for repeated-measures data. J Am Stat Assoc 1988: 83: 1014–1022.

    Google Scholar 

  • Littell R.C., Milliken G.A., Stroup W.W., and Wolfinger R.D . SAS system for mixed models. SAS Institute Inc., Cary NC, 1996.

  • Maggi C.A., Giachetti A., Dey R.D., and Said S.I . Neuropeptides as regulators of airway function: vasoactive intestinal peptide and the tachykinins. Physiol Rev 1995: 75: 277–322.

    Article  CAS  Google Scholar 

  • Meggs W.J . Neurogenic inflammation and sensitivity to environmental chemicals. Environ Health Perspect 1993: 101: 234–238.

    Article  CAS  Google Scholar 

  • Molhave L., Bach B., and Peterson F . Human reaction to low concentrations of volatile organic compounds. Environ Int 1986: 12: 167–175.

    Article  Google Scholar 

  • National Heart, Lung, and Blood Institute (NHLBI). The Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma. (Publication No. 97-4051) NHLBI, National Institutes of Health, Bethesda, MD, 1997.

  • Nel A.E., Diaz-Sanchez D., and Li N . The role of particulate pollutants in pulmonary inflammation and asthma: evidence for the involvement of organic chemicals and oxidative stress. Curr Opin Pulm Med 2001: 7: 20–26.

    Article  CAS  Google Scholar 

  • Norback D., Bjornsson E., Janson C., Widstrom J., and Boman G . Asthmatic symptoms and volatile organic compounds, formaldehyde, and carbon dioxide in dwellings. Occup Env Med 1995: 52: 388–395.

    Article  CAS  Google Scholar 

  • Pandya R.J., Solomon G., Kinner A., and Balmes J.R . Diesel exhaust and asthma: hypotheses and molecular mechanisms of action. Environ Health Perspect 2002: 110 (Suppl 1): 103–112.

    Article  CAS  Google Scholar 

  • Pellizzari E.D., Wallace L.A., and Gordon S.M . Elimination kinetics of volatile organics in humans using breath measurements. J Expo Anal Environ Epidemiol 1992: 2: 341–355.

    CAS  Google Scholar 

  • Raymer J.H., Thomas K.W., Cooper S.D., Whitaker D.A., and Pellizzari E.D . A device for sampling of human alveolar breath for the measurement of expired volatile organic compounds. J Anal Toxicol 1990: 14: 337–344.

    Article  CAS  Google Scholar 

  • SAS Institute. SAS OnlineDoc, Version Eight. SAS Institute Gary, NC, February 2000 HTML Format.

  • Sarnat J.A., Schwartz J., Catalano P.J., and Suh H.H . Gaseous pollutants in particulate matter epidemiology: confounders or surrogates? Environ Health Perspect 2001: 109: 1053–1061.

    Article  CAS  Google Scholar 

  • South Coast Air Quality Management District (SCAQMD). Multiple Air Toxics Exposure Study in the South Coast Air Basin (MATES-II): Final Report and Appendices. South Coast Air Quality Management District, Diamond Bar, CA, 2000.

  • Thompson A.J., Shields M.D., and Patterson C.C . Acute asthma exacerbations and air pollutants in children living in Belfast, Northern Ireland. Arch Environ Health 2001: 56: 234–241.

    Article  CAS  Google Scholar 

  • Wallace L., Buckley T., Pellizzari E., and Gordon S . Breath measurements as volatile organic compound biomarkers. Environ Health Perspect 1996: 104 (Suppl 5): 861–869.

    Article  CAS  Google Scholar 

  • Wallace L., Nelson W., Ziegenfus R., Pellizzari E., Michael L., Whitmore R., Zelon H., Hartwell T., Perritt R., and Westerdahl D . The Los Angeles TEAM study: personal exposures, indoor–outdoor air concentrations, and breath concentrations of 25 volatile organic compounds. J Expo Anal Environ Epidemiol 1991: 1: 157–192.

    CAS  Google Scholar 

  • Wallace L., Pellizzari E., and Gordon S . A linear model relating breath concentrations to environmental exposures: application to a chamber study of four volunteers exposed to volatile organic chemicals. J Expo Anal Environ Epidemiol 1993: 3: 75–102.

    CAS  Google Scholar 

  • Ware J.H., Spengler J.D., and Neas L.M. et al. Respiratory and irritant health effects of volatile organic compounds: the Kanawha County Health Study. Am J Epidemiol 1993: 137: 1287–1301.

    Article  CAS  Google Scholar 

  • Wieslander G., Norbäck D., Björnsson E., Janson C., and Boman G. Asthma and the indoor environment: the significance of emission of formaldehyde and volatile organic compounds from newly painted surfaces. Int Arch Occup Environ Health 1997: 69: 115–124.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank our research assistants at the Epidemiology Division, UCI (Josh Floro Victor Gastaña; and Greg Warner), at the Los Amigos Research and Education Institute (Marisela Avila, Kenneth W. Clark, Sheryl Terrell, and Lester Terrell), and at the Research Triangle Institute (J. Liu and W. Shi). We also thank staff at the South Coast Air Quality Management District for providing stationary site data for air pollutants (Mel Zeldin and Rudy Eden). We also thank Dane Westerdahl and Shankar Prasad at the California Air Resources Board (CARB) for their helpful comments during the development of the protocol. This project was cofunded by CARB contract no. 99-302 to the Epidemiology Division, Department of Medicine, University of California, Irvine, and by the South Coast Air Quality Management District contract no. 990994 to the Los Amigos Research and Education Institute. Dr. Gong was supported by NIEHS #1P01 ES09581-01 and US EPA#R826708-01-0.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ralph J Delfino.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Delfino, R., Gong, H., Linn, W. et al. Respiratory symptoms and peak expiratory flow in children with asthma in relation to volatile organic compounds in exhaled breath and ambient air. J Expo Sci Environ Epidemiol 13, 348–363 (2003). https://doi.org/10.1038/sj.jea.7500287

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jea.7500287

Keywords

  • epidemiology
  • panel study
  • exposure biomarkers
  • hazardous air pollutants
  • air pollution.

This article is cited by

Search

Quick links