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

Pediatric Research (2024)Cite this article

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 PM2.5, NO, and SO2 was estimated using land-use regression models data on children’s school and home addresses.

Results

Annual exposure to PM2.5 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 PM2.5 (P < 0.05). An increase of 1 μg/m3 PM2.5 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 PM2.5 posed a significant risk of asthma prevalence and airway inflammation in a community-based population of children.

Impact

  • Annual exposure to PM2.5 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 PM2.5 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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Fig. 1: Geographic distribution of study townships and coal-fired power plants in central Taiwan.

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Data availability

The datasets generated during the current study are available from the corresponding author upon reasonable request and with permission of Changhua County Ministry of Health and institutional review board (Changhua Christian Hospital IRB).

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Acknowledgements

We are thanks to Drs: Kao JK, Yong SB, and Lee MS for enrolled cases. The authors are grateful to professors Drs: JL Huang, and YL Lee for their agreement with Chinese version of the ISAAC and environmental questionnaires in the survey. We are grateful to the school principals, teachers, students and parents in each township for their cooperation and especially to the members of the health testing field team for their efforts. This paper was financially supported by the ‘Innovation and Policy Center for Population Health and Sustainable Environment (Population Health Research Center, PHRC), College of Public Health, National Taiwan University’ from The Featured Areas Research Center Program within the framework of the Higher Education Sprout Project by the Ministry of Education (MOE) in Taiwan.

Funding

This study was supported by the Ministry of Science and Technology (grant number NSTC 112-2314-B-371-006 & MOST 111-2314-B-371-006 & 106-2314-B-371-008 & 109-2634-F-002-044), and Featured Areas Research Center Program within the framework of the Higher Education Sprout Project by the Ministry of Education (MOE) in Taiwan (grant number NTU-109L9003), Changhua Christian Hospital (111-CCH-IRP-018; 111-CCH-MST-134, 110-CCH-ICO-152, 112-CCH-ICO-152, 112-CCH-IRP-022) and National Health Research Institutes (EO-110-PP-10), and Academia Sinica, Taiwan (AS-SS-111-02-1).

Author information

Author notes

  1. These authors contributed equally: Chia-Pin Chio, Kuender D. Yang, Ching-Hsiung Lin, Shu-Li Wang, Shau-Ku Huang, Chang-Chuan Chan.

Authors and Affiliations

  1. Department of Pediatrics, Changhua Christian Children’s Hospital, Changhua, Taiwan, ROC

    Yi-Giien Tsai & Jien-Wen Chien

  2. School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC

    Yi-Giien Tsai

  3. School of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC

    Yi-Giien Tsai

  4. Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, ROC

    Yi-Giien Tsai & Jien-Wen Chien

  5. Department of Medical Research, Tungs’ Taichung MetroHarbor Hospital, Taichung, Taiwan, ROC

    Chia-Pin Chio

  6. Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan, ROC

    Chia-Pin Chio & Chang-Chuan Chan

  7. Department of Pediatrics, Mackay Memorial Hospital, and Department of Microbiology & Immunology, National Defense Medical Center, Taipei, Taiwan, ROC

    Kuender D. Yang

  8. Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan, ROC

    Ching-Hsiung Lin

  9. Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan, ROC

    Ching-Hsiung Lin

  10. Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan, ROC

    Ching-Hsiung Lin

  11. Department of Recreation and Holistic Wellness, MingDao University, Changhua, Taiwan, ROC

    Ching-Hsiung Lin

  12. Changhua County Public Health Bureau, Changhua, Taiwan, ROC

    Yen-Po Yeh

  13. Epidemiology and Biostatistics Center, Changhua Christian Hospital, Changhua, Taiwan, ROC

    Yu-Jun Chang

  14. National Institute of Environmental Health Sciences, National Health Research Institutes, 35 Keyan Rd, Zhunan, Miaoli County, Miaoli, Taiwan, ROC

    Shu-Li Wang & Shau-Ku Huang

  15. Johns Hopkins Asthma and Allergy Center, School of Medicine, Johns Hopkins University, Baltimore, MD, USA

    Shau-Ku Huang

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  1. Yi-Giien Tsai
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Contributions

C.-P.C., K.D.Y., C.-H.L., Y.-P.Y., and J.-W.C. conceptualized and designed the study and collected the data. Y.-G.T., Y.-J.C. and S.-L.W. analyzed the data and drafted the manuscript. S.-K.H. and C.-C.C. revised it critically for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding authors

Correspondence to Shu-Li Wang, Shau-Ku Huang or Chang-Chuan Chan.

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Tsai, YG., Chio, CP., Yang, K.D. et al. Long-term PM2.5 exposure is associated with asthma prevalence and exhaled nitric oxide levels in children. Pediatr Res (2024). https://doi.org/10.1038/s41390-023-02977-5

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  • DOI: https://doi.org/10.1038/s41390-023-02977-5

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