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Published ahead of print on October 27, 2005, doi:10.1164/rccm.200408-1123OC

Am. J. Respir. Crit. Care Med., Volume 173, Number 3, February 2006, 297-303

A more recent version of this article appeared on February 1, 2006
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Submitted on August 26, 2004
Accepted on October 27, 2005

Association of Indoor Nitrogen Dioxide Exposure with Respiratory Symptoms in Asthmatic Children

Kathleen Belanger1*, Janneane F Gent1, Elizabeth W Triche1, Michael B Bracken1, and Brian P Leaderer1

1 Yale Center for Perinatal, Pediatric and Environmental Epidemiology of the Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut, USA

* To whom correspondence should be addressed. E-mail: kathleen.belanger{at}yale.edu.

Rationale: Chronic exposure to indoor nitrogen dioxide(NO2) is a public health concern. Over half of US households have a source of NO2, and experimental data suggests potential for adverse respiratory effects. Objective: To examine associations of indoor NO2 exposure with respiratory symptoms among asthmatic children. Methods: NO2 was measured using Palmes tubes, and respiratory symptoms in the month prior to sampling were collected during home interviews of mothers of 728 children with active asthma. All were younger than 12 years; lived at sampled home for at least 2 months; had asthma symptoms or used maintenance medication within previous year. Measurements: Respiratory symptoms (wheeze, persistent cough, shortness of breath, chest tightness). Results: Mean(SD) NO2 was 8.6 (9.1) ppb in homes with electric ranges; 25.9 (18.1) ppb in homes with gas stoves. In models stratified by housing type gas stove presence and elevated NO2 were each significantly associated with respiratory symptoms, controlling for age, ethnicity, medication, mold/mildew, water leaks, season of sampling. Among children in multifamily housing, exposure to gas stoves increased likelihood of wheeze (Odds Ratio (OR) [95% Confidence Interval (CI)] 2.27 [1.15,4.47]), shortness of breath (2.33 [1.12,5.06]) and chest tightness (4.34 [1.76,10.69]). Each 20 ppb increase in NO2 increased both likelihood of any wheeze (1.52 [1.04,2.21])or chest tightness (1.61 [1.04,2.49]), and days of wheeze (1.33 [1.05,1.68])or chest tightness (1.51 [1.18,1.91]). Conclusion: Exposure to indoor NO2, at levels well below the EPA outdoor standard (53 ppb), is associated with respiratory symptoms among asthmatic children in multifamily housing.


Key words: nitrogen dioxide, asthma, respiratory symptoms, children, indoor environment




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