Download Carbon in Airway Macrophages and Lung Function in

CONCLUSIONS. The authors concluded that there is an asso-
REVIEWER COMMENTS. The reduction in pulmonary function
ciation between exposure to high levels of indoor NO2
and respiratory symptoms in children with physiciandiagnosed asthma. This association, however, was limited to children who lived in multifamily homes, probably because of the smaller size (and air volume) of the
apartments. The authors also suggested a strong association of NO2 exposure with housing characteristics,
lower socioeconomic status, and ethnicity.
in this cohort of children who did not have current
lower airway symptoms is in the same order of magnitude as patients with moderate persistent asthma, which
underscores the need for less toxic energy sources.
REVIEWER COMMENTS. This study demonstrated an associa-
tion between increased NO2 levels and asthma symptoms of children in multifamily homes. The important
potential confounders in the analysis should have been
adequately dealt with in the logistic regression analysis
used. The biological basis of the association is poorly
understood, and the value of intervention to reduce
exposure is speculative. Additional studies will be
needed to clarify and confirm the association.
URL: www.pediatrics.org/cgi/doi/10.1542/peds.2007-0846T
Mary Dell Railey, MD
Susan S. Laubach, MD
Larry W. Williams, MD
Durham, NC
Carbon in Airway Macrophages and Lung
Function in Children
Kulkarni N, Pierse N, Rushton L, Grigg J. N Engl
J Med. 2006;355:21–30
PURPOSE OF THE STUDY. To define the extent of pulmonary-
function abnormalities that may be attributed to exposures to particulate matter with a median aerodynamic
diameter of ⬍10 ␮m (PM10) as a result of fossil fuel
combustion.
STUDY POPULATION. The study included 114 children (aged 8
to 15 years) without any chronic respiratory condition
who were living in the same residence for 1 year. All
children had a forced expiratory volume in 1 second
(FEV1) of ⬎80% predicted.
METHODS. Pulmonary-function testing and induced spu-
tum were obtained on the same day. PM10 values from
all sources were collected for 1 year. The results were
controlled for passive tobacco-smoke exposure.
RESULTS. A total of 62 (56%) of the 114 subjects were able
to produce sputum. An increase of 1 ␮
in PM10 was
associated with an increase of 0.10 ␮m2 in the carbon
content of airway macrophages. Each 1.0 ␮m2 increase
in carbon content was associated with a significant decrease in pulmonary function (decrease of 17% in FEV1,
12.9% in forced vital capacity, and 34.7% in forced
expiratory flow, midexpiratory phase).
g/m3
CONCLUSIONS. A significant reduction in pulmonary func-
tion resulted from increased exposure to products of
fossil fuel combustion.
S114
BEST ARTICLES RELEVANT TO PEDIATRIC ALLERGY AND IMMUNOLOGY
URL: www.pediatrics.org/cgi/doi/10.1542/peds.2007-0846U
Bradley E. Chipps, MD
Sacramento, CA
Particulate Levels Are Associated With Early
Asthma Worsening in Children With
Persistent Disease
Rabinovitch N, Strand M, Gelfand EW. Am J Respir Crit
Care Med. 2006;173:1098 –1105
PURPOSE OF THE STUDY. To determine if exposure to particu-
late matter has immediate effects on asthma control in
children with persistent disease.
STUDY POPULATION. Seventy-three schoolchildren (aged
6 –13 years) with physician-diagnosed asthma in Denver, Colorado, were studied.
METHODS. Over 2 consecutive winters, the subjects were
followed daily. The association among ambient fineparticulate levels, bronchodilator use, and urinary leukotriene E4 levels was assessed.
RESULTS. Fine-particulate concentrations peaked in the
morning hours during hours when children were commuting to school. Children with severe asthma had a
stronger association (⫹8.1%) than those with mild-tomoderate disease (⫹1.6%), with increased bronchodilator usage at school on days with an increase of 1
interquartile range in morning maximum fine-particulate levels. Morning maximum fine-particulate levels
were also associated with urinary leukotriene E4 measured during school hours (average increase of 6.2% per
interquartile-range increase).
CONCLUSIONS. Peak concentrations of ambient fine particulate are associated with early increases in bronchodilator use and urinary leukotriene E4 levels among
children with persistent asthma, despite the use of controller medications.
REVIEWER COMMENTS. Managing patients with asthma re-
quires knowing possible triggers. This study examined
the timing of particulate associations with disease control in children with moderate or severe asthma who
were taking controller medications. The interval between exposure and initiation of health effects was seen
to occur within the first few minutes or hours after
exposure. The effects were strongest in children with
more severe asthma. This effect plus the increase in
urinary leukotriene E4 levels suggest that in children
with persistent asthma, particulate exposure may lead to
early release of mediators related to asthma worsening.
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Carbon in Airway Macrophages and Lung Function in Children
Bradley E. Chipps
Pediatrics 2007;120;S114
DOI: 10.1542/peds.2007-0846U
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PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly
publication, it has been published continuously since 1948. PEDIATRICS is owned, published,
and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk
Grove Village, Illinois, 60007. Copyright © 2007 by the American Academy of Pediatrics. All
rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.
Downloaded from by guest on August 1, 2017
Carbon in Airway Macrophages and Lung Function in Children
Bradley E. Chipps
Pediatrics 2007;120;S114
DOI: 10.1542/peds.2007-0846U
The online version of this article, along with updated information and services, is
located on the World Wide Web at:
/content/120/Supplement_3/S114.1
PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly
publication, it has been published continuously since 1948. PEDIATRICS is owned,
published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point
Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2007 by the American Academy
of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.
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