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Health effects of concurrent ambient and tobacco smoke-derived particle exposures at low concentrations in children with asthma

Journal of Exposure Science & Environmental Epidemiology volume 30, pages 785–794 (2020)Cite this article

Abstract

Exposure to particulate matter less than 2.5 microns from either ambient pollution (AMB-PM2.5) or secondhand smoke (SHS-PM2.5) have been associated with asthma worsening, but there is little information on effects and relative potency with concurrent exposures. We studied health effects of concurrent exposures to AMB-PM2.5 and SHS-PM2.5 over a 6-year period in schoolchildren with asthma. Regression calibration with instrumental variables (RCIV) was utilized to estimate effects of personal exposure to low-level SHS and AMB-PM2.5 on daily albuterol usage and urinary leukotriene E4 (uLTE4; a biomarker of asthma-related inflammation) using urine cotinine and concentrations from fixed and personal pollution monitors. Each IQR increase in SHS-PM2.5 exposure was associated with a 6.7% increase (95% CI: 1.0–12.8%) in uLTE4 on the same day and 9.4% increase (95% CI: −2.6 to 22.7%) in albuterol use the next day, when children were co-exposed to mean levels of AMB-PM2.5. The dose-response relationship between health outcomes and one pollutant was higher at lower levels of the other pollutant. For example, at lower levels of predicted SHS-PM2.5 exposure, increases in health outcomes per IQR increase in AMB-PM2.5 ranged between 2 and 5%, but were negligible at higher SHS-PM2.5 levels. Comparing at equivalent co-exposure levels, SHS-PM2.5 was 1.6 times more potent than AMB-PM2.5 for uLTE4 (95% CI: 1.1–2.3); estimates for albuterol usage were similar but less significant. Effects at mean co-exposure levels were closer [SHS to AMB-PM2.5 potency ratio = 1.2 (95% CI: 0.9–1.5) for uLTE4 and 1.2 (95% CI: 0.7–1.9) for albuterol usage]. In summary, concurrent exposure to relatively low levels of SHS and AMB-PM2.5 were associated with health outcomes in asthmatic schoolchildren. Dose responses varied with changes in the relative amounts of each pollutant; SHS-PM2.5 was observed to be more potent than AMB-PM2.5 when co-exposure levels were equivalent.

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Fig. 1: Relative potency of pollutants.

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Acknowledgements

We would like to thank Arden Pope for his review and helpful comments on this paper.

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  1. These authors contributed equally: Matthew Strand, Nathan Rabinovitch

Authors and Affiliations

  1. Division of Biostatistics, National Jewish Health, Denver, CO, USA

    Matthew Strand

  2. Department of Pediatrics, National Jewish Health, Denver, CO, USA

    Nathan Rabinovitch

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  1. Matthew Strand
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Correspondence to Matthew Strand.

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Strand, M., Rabinovitch, N. Health effects of concurrent ambient and tobacco smoke-derived particle exposures at low concentrations in children with asthma. J Expo Sci Environ Epidemiol 30, 785–794 (2020). https://doi.org/10.1038/s41370-020-0201-y

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