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Am. J. Respir. Crit. Care Med., Volume 158, Number 6, December 1998, 1848-1854

Peak Expiratory Flow Variability, Bronchial Responsiveness, and Susceptibility to Ambient Air Pollution in Adults

MARIKE BOEZEN, JAN SCHOUTEN, BERT RIJCKEN, JUDITH VONK, JORRIT GERRITSEN, SASKIA van der ZEE, GERARD HOEK, BERT BRUNEKREEF, and DIRKJE POSTMA

Departments of Epidemiology and Statistics, University of Groningen; Pediatric Pulmonology, and Pulmonology, University Hospital Groningen, Groningen; and Environmental Sciences, Environmental and Occupational Health Unit, University of Wageningen, Wageningen, The Netherlands

Bronchial hyperresponsiveness (BHR) and peak expiratory flow (PEF) variability are associated expressions of airway lability, yet probably reflect different underlying pathophysiologic mechanisms. We investigated whether both measures can be used interchangeably to identify subjects who are susceptible to ambient air pollution. Data on BHR (>=  20% fall in FEV1), PEF variability (ampl%mean PEF > 5% on any day during an 8-d period with low air pollution levels) and diary data on upper and lower respiratory symptoms, cough, and phlegm were collected in 189 subjects (48-73 yr). The acute effects (lag0) of particulate matter with a diameter less than 10 µm (PM10), black smoke, SO2 and NO2 on the prevalence of symptoms were estimated with logistic regression. In subjects with airway lability, both when expressed as PEF variability (69%) and BHR (28%), the prevalence of symptoms increased significantly with increasing levels of air pollution, especially in those with the greater PEF variability (n = 55, 29%). We found no such consistent positive associations in adults without airway lability. PEF variability, and to a smaller extent BHR, can be used to identify adults who are susceptible to air pollution. Though odds ratios were rather low (ranging from 1.13 to 1.41), the impact on public health can be substantial because it applies to large populations.




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