Air Pollution and Recent Symptoms of Asthma, Allergic Rhinitis, and Atopic Eczema in Schoolchildren Aged Between 6 and 7 Years

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  Originles Utilidd de l punción spirtiv trnsbronquil guid con ultrsonogrfí endobronquil (USEB) rdil pr el dignóstico de denoptís medistínics Creencis sobre l slud y los medicmentos en l poblción smátic
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Originles Utilidd de l punción spirtiv trnsbronquil guid con ultrsonogrfí endobronquil (USEB) rdil pr el dignóstico de denoptís medistínics Creencis sobre l slud y los medicmentos en l poblción smátic espñol. Vlidción de 2 instrumentos pr su medid Contminción del ire y síntoms recientes de sm, rinitis lérgic y eccem tópico en escolres de 6 y 7 ños El slbutmol mejor l contrctilidd difrgmátic en l obstrucción crónic de l ví ére Análisis de supervivenci de l cirugí de resección de metástsis pulmonres de cáncer colorrectl Órgno Oficil de l Sociedd Espñol de Neumologí y Cirugí Torácic (SEPAR), l Asocición Ltinomericn del Tórx (ALAT) y l Asocición Iberomericn de Cirugí Torácic (AIACT) Revisión Síndrome de pnes-hipopnes durnte el sueño sin somnolenci Artículo especil Archivo de Archivos: Incluid en: Excerpt Medic/EMBASE, Index Medicus/MEDLINE, Current Contents/Clinicl Medicine, ISI Alerting Services, Science Cittion Index Expnded, Journl Cittion Reports, SCOPUS, ScienceDirect Document downloded from dy 31/12/2017. This copy is for personl use. Any trnsmission of this document by ny medi or formt is strictly prohibited. Arch Bronconeumol. 2009;45(5): Archi os de Bronconeumologí Archivos de Bronconeumolog íissn: Volumen 45, Número 5, Myo M o 2009 Volumen 45 Número 5 Págs ORIGINAL ARTICLE Air Pollution nd Recent Symptoms of Asthm, Allergic Rhinitis, nd Atopic Eczem in Schoolchildren Aged Between 6 nd 7 Yers Alberto Arnedo-Pen,, * Luis Grcí-Mrcos, b Igncio Crvjl Urueñ, c Ros Busquets Monge, d Mrí Morles Suárez-Vrel, e Izskun Miner Cnflnc, f José Btlles Grrido, g Alfredo Blnco Quirós, h Ángel López-Silvrrey Vrel, i Glori Grcí Hernández, j Inés Aguing Ontoso, k nd Crlos González Díz l Sección de Epidemiologí, Centro de Slud Públic, Cstellón, Spin b Uniddes de Neumologí y de Alergi Pediátric, Hospitl Infntil Universitrio Virgen de l Arrixc, CIBER Epidemiologí y Slud Públic (CIBERESP), Murci, Spin c Centro de Slud L Erí, Servicio de Slud del Principdo de Asturis, Oviedo, Asturis, Spin d Deprtmento de Peditrí, Hospitl del Mr, Brcelon, Spin e Unidd de Slud Públic y Medio Ambiente, Deprtmento de Medicin Preventiv, Universidd de Vlenci, CIBER CB06/02/0045, CIBER Actions-Epidemiologí y Slud Públic, Fundción pr l Investigción, Grupo de investigción, Hospitl Universitrio Dr. Peset, Vlenci, Spin f Deprtmento de Peditrí, Hospitl Donosti, Sn Sebstián, Guipúzco, Spin g Unidd de Neumologí Infntil, Servicio de Peditrí, Hospitl Torrecárdens, Almerí, Spin h Deprtmento de Peditrí, Universidd de Vlldolid, Vlldolid, Spin i Fundción Mrí José Jove, L Coruñ, Spin j Unidd de Neumologí y Alergi Pediátric, Hospitl Infntil 12 de Octubre, Mdrid, Spin k Deprtmento de Epidemiologí, Ayuntmiento de Pmplon, Pmplon, Nvrr, Spin l Deprtmento de Peditrí, Hospitl de Bsurto, Bilbo, Vizcy, Spin ARTICLE INFO ABSTRACT Article history: Received Mrch 10, 2008 Accepted October 20, 2008 Avilble online April 16, 2009 Keywords: Asthm Air pollution Sulfur dioxide Nitrogen dioxide Atopic eczem Schoolchildren Allergic rhinitis Objective: The objective of the study ws to nlyze the reltionship between ir pollutnts nd the prevlence of recent symptoms of sthm, llergic rhinitis, nd topic eczem in schoolchildren ged between 6 nd 7 yers. Ptients nd Methods: The prevlence of recent (previous 12 months) symptoms of llergic diseses ws obtined by mens of the questionnire of the Interntionl Study of Asthm nd Allergies in Childhood (ISAAC), Spin, with the prticiption of 7 centers (Asturis, Brcelon, Bilbo, Crtgen, L Coruñ, Mdrid, nd Vlenci) nd schoolchildren ged between 6 nd 7 yers, from 2002 to The pollutnt detection systems of the forementioned centers provided the men nnul concentrtions of sulfur dioxide ( ), nitrogen dioxide (NO 2 ), crbon monoxide (CO), nd totl suspended prticulte mtter. Results: The nnul verge concentrtion of showed significnt ssocition with higher prevlence of recent severe sthm (djusted odds rtio [OR] between level-1 nd level-3 pollution, 1.32; 95% confidence intervl [CI], ), rhinitis (OR, 1.56; 95% CI, ), nd rhinoconjunctivitis (OR, 1.70; 95% CI, ). The nnul verge concentrtion of CO ws ssocited with higher prevlence of rhinitis (OR, 1.65; 95% CI, ), rhinoconjunctivitis (OR, 1.76; 95% CI, ), nd eczem (OR, 1.55; 95% CI, ). The nnul verge concentrtion for NO 2 nd totl suspended prticulte mtter showed inverse ssocitions with the prevlence of nocturnl dry cough. Conclusions: Findings suggest tht ir pollutnts such s nd CO increse the risk of recent symptoms of sthm nd llergic rhinitis in schoolchildren ged between 6 nd 7 yers in Spin SEPAR. Published by Elsevier Espñ, S.L. All rights reserved. * Corresponding uthor. E-mil ddress: (A. Arnedo-Pen) /$ - see front mtter 2008 SEPAR. Published by Elsevier Espñ, S.L. All rights reserved. Document downloded from dy 31/12/2017. This copy is for personl use. Any trnsmission of this document by ny medi or formt is strictly prohibited. A. Arnedo-Pen et l / Arch Bronconeumol. 2009;45(5): Plbrs clve: Asm Contminción tmosféric Dióxido de zufre Dióxido de nitrógeno Atopic eczem Escolres Rinitis lérgic Contminción del ire y síntoms recientes de sm, rinitis lérgic y eccem tópico en escolres de 6 y 7 ños RESUMEN Introducción: El objetivo del estudio h sido nlizr l relción entre contminntes del ire y l prevlenci de síntoms recientes de sm, rinitis lérgic y eccem tópico, en escolres de 6 y 7 ños. Pcientes y métodos: L prevlenci de síntoms de enfermeddes lérgics recientes (últimos 12 meses) se obtuvo medinte el cuestionrio del estudio ISAAC (Interntionl Study of Asthm nd Allergies in Childhood) Espñ, con l prticipción de 7 centros (Asturis, Brcelon, Bilbo, Crtgen, L Coruñ, Mdrid y Vlenci) y escolres de 6 y 7 ños, durnte De los sistems de detección de contminntes de los centros citdos se obtuvieron dtos de ls concentrciones nules medis de dióxido de zufre ( ), dióxido de nitrógeno (NO 2 ), monóxido de crbono (CO) y totl de prtículs en suspensión. Resultdos: L concentrción medi nul (CMA) de se soció significtivmente con un myor prevlenci de sm grve reciente (odds rtio justd [OR], nivel 3 sobre nivel 1 de contminción=1,32; intervlo de confinz [IC] del 95%, 1,01 1,73), rinitis (OR = 1,56; IC del 95%, 1,39 1,75) y rinoconjuntivitis (OR = 1,70; IC del 95%, 1,45 2,00). L CMA de CO se soció con un prevlenci más lt de rinitis (OR = 1,65; IC del 95%, 1,34 2,04), rinoconjuntivitis (OR = 1,76; IC del 95%, 1,31 2,37) y eccem tópico (OR = 1,55; IC del 95%, 1,17 2,04). Ls CMA de NO 2 y de totl de prtículs en suspensión presentron sociciones inverss con l prevlenci de tos sec nocturn. Conclusiones: Se indic qué contminntes del ire, como y CO, incrementn el riesgo de síntoms recientes de sm y rinitis lérgic en escolres de 6 y 7 ños de nuestro medio SEPAR. Publicdo por Elsevier Espñ, S.L. Todos los derechos reservdos. Introduction The effect of ir pollution on llergic diseses is the subject of debte. Some reserchers consider it to be responsible for the observed increse in these diseses in the peditric popultion of developed countries, wheres others believe its effect to be slight. 1,2 Epidemiologic reserch on ir pollution s potentil risk fctor for llergic diseses hs incresed in recent yers despite the considerble methodologicl difficulties involved. These difficulties include the following: type of study design; pollutnts to be evluted, their mesurement, nd the interctions between them; dignosis of symptoms or diseses in the short or long term nd whether they re llergic or not; popultions studied; potentil confounding fctors, climte, geogrphic, nd socioeconomic vribles; nd the sttisticl models. Severl epidemiologic studies hve found tht exposure to ir pollutnts nd trffic exhust fumes is ssocited with the risk of developing llergic rhinitis 3 nd sthm 4,5 in peditric popultions; other studies, however, were not ble to show these effects nd the debte remins open. 6 The Interntionl Study of Asthm nd Allergies in Childhood (ISAAC) hs mde it possible to obtin stndrdized mesurements of symptoms of these diseses in school-going popultions, with lrge smple sizes. 7 Spin currently hs stndrdized mesurements of ir pollutnts in severl cities, obtined vi the monitoring networks mnged by the regionl environmentl gencies nd city councils. 8 However, studies on the impct of ir pollution on peditric popultions re rre in Spin. Phse III of the ISAAC study ws crried out in Spin during 2002 with the prticiption of 8 centers. 9 Considerble differences were observed in the study of the geogrphic distribution of the prevlence of sthm nd llergic rhinitis. 10,11 One of the working hypotheses ws tht the estimted differences might be linked to the ir pollutnts in the respective centers. The objective of this study ws to nlyze the ssocition between ir pollutnts nd the prevlence of recent symptoms of sthm, llergic rhinitis, nd topic eczem. Ptients nd Methods We performed semi-individul popultion-bsed study 12 bsed on the ISAAC cross-sectionl study. This study presents 3 stndrdized questionnires to estimte the prevlence of sthm, llergic rhinitis, nd topic eczem; the questionnires were to be completed by the prents of schoolchildren between the ges of 6 nd 7 yers. Permission for the children to tke prt in the study ws obtined from their prents nd the Asturis regionl ethics committee pproved the study for ll the centers. Complete informtion on risk fctors ws obtined in the following 6 of the 8 centers tking prt in phse III of the ISAAC study: Asturis, Brcelon, Bilbo, Crtgen, Mdrid, nd Vlenci, together with L Coruñ, which performed the study in The medin prticiption of the school-going popultion ws 77.4% (rnge, 89.2%-53.4%). The exposure vribles correspond to the men concentrtions over 24 hours of the ir pollutnts sulfur dioxide ( ), nitrogen dioxide (NO 2 ), crbon monoxide (CO), nd totl suspended prticulte mtter (TSP) in 2002, except in the cse of Mdrid nd L Coruñ, where the figures correspond to This informtion nd the men nnul figures for temperture nd reltive humidity were obtined from the environmentl gencies of the utonomous communities of Asturis, Ctloni, Glici, Mdrid, Murci, Bsque Country, nd Vlenci. We considered 3 levels of exposure, ccording to men nnul levels of pollutnts (percentiles 0-25 [level 1], percentiles [level 2], nd percentile 75 or higher [level 3]). For Brcelon nd Mdrid, the dt were obtined from the sttions ner the ISAAC centers in these cities nd for Asturis, dt were obtined from the towns of Avilés, Gijón, nd Oviedo. The vribles (recent symptoms of sthm, llergic rhinitis, nd topic eczem) were collected from the ISAAC questionnire 10,11 nd cses were considered using the definitions shown in Tble 1. As well s the ISAAC questionnire, the prents completed n environmentl questionnire on risk fctors tht ws developed by the ISAAC center in New Zelnd (http://isc.ucklnd.c.nz) nd included questions relting to the type of energy used in the home, the presence of nimls in the home, exposure to tobcco smoke, use of ntibiotics nd prcetmol, number of older siblings, mother s eductionl level, use of orl contrceptives by the mother, nd brestfeeding. These fctors nd the men nnul figures for temperture nd humidity were studied s potentil confounding fctors. The question on the frequency of trucks pssing through the street where the child s home is locted ws not included in order to prevent overdjustment with the studied pollutnts. Document downloded from dy 31/12/2017. This copy is for personl use. Any trnsmission of this document by ny medi or formt is strictly prohibited. 226 A. Arnedo-Pen et l / Arch Bronconeumol. 2009;45(5): Tble 1 Definitions of Cses of Recent Symptoms of Asthm, Allergic Rhinitis, nd Atopic Eczem, Bsed on the ISAAC Questionnire 1. Recent wheezing Affirmtive nswer to the question, Hs your child hd chest wheezing in the pst 12 months? 2. Recent severe sthm Affirmtive nswer to the question on recent wheezing nd ny of the following nswers to the following questions: How mny ttcks of wheezing hs your child hd in the pst 12 months? 4 or more ttcks How mny times hs your child woken up in the night due to wheezing in the pst 12 months? One or more nights per week In the pst 12 months, ws the chest wheezing severe enough for your child to hve to stop to brethe every 2 words? Yes 3. Nocturnl dry cough Affirmtive nswer to the question, Hs your child hd dry cough t night prt from cough ssocited with cold or chest infection, in the pst 12 months? 4. Rhinitis Affirmtive nswer to the question, Hs your child suffered from sneezing, or runny or blocked nose not ssocited with cold or flu in the pst 12 months? 5. Rhinoconjunctivitis Affirmtive nswer to the question, Hs your child hd these nose problems ccompnied by itchy, wtery eyes in the pst 12 months? 6. Atopic eczem Affirmtive nswer to the question on the loction of red mrks in the pst 12 months: Did these itchy red mrks pper in one of the following plces: elbowjoint fold, behind the knees, on the instep, under the buttocks, round the neck, eyes or ers? Sttisticl Anlysis The prevlence of symptoms ws clculted by dividing the totl number of prticipnts in ech ISAAC center by the number of cses. The Person product moment correltion ws used to study the correltions between the pollutnts. Multivrite logistic regression models were used to quntify the ssocitions between exposures nd the result vribles. Ech result vrible nd the potentil confounding fctors were studied, nd fctors with sttisticl significnce of P=.25 were included in the model to obtin finl model with ssocited fctors with significnce of P .05. When this model ws obtined, we incorported the concentrtions of pollutnts in the 3 levels described, nd the odds rtios (OR), their tendency, nd the 95% confidence intervls (CI) were clculted. We used the STATA sttisticl softwre pckge, version 6.0 (Stt Corportion, College Sttion, Texs, USA). The goodness of fit of the models ws studied using the Hosmer-Lemeshow goodness-of-fit test. Results The study included schoolchildren between the ges of 6 nd 7 yers (49.8% boys) from the 7 centers (Tble 2). Three of the centers were locted in the Mediterrnen re, 1 in centrl Spin, nd 3 in the Atlntic re. The medin temperture ws 14.6 C nd the medin reltive humidity ws 73%. Tble 3 shows summry of the men nnul concentrtions of pollutnts in the ISAAC centers. There were considerble differences between the centers, prticulrly for NO 2 nd. The minimum for NO 2 ws 9.6 g/m 3 (24 h) nd the mximum ws 59.9 g/m 3 (24 h), where s the minimum nd mximum for were 4.0 nd 19.9 g/ m 3 (24 h), respectively. The correltions of the pollutnts (Tble 4) were positive between nd CO nd between NO 2 nd TSP; the correltions were negtive between the other pollutnts. Prevlences of recent symptoms (Tble 5) showed lrge differences between the centers, prticulrly for nocturnl dry cough nd rhinitis. Tble 6 shows the results of the logistic regression nlysis. The men nnul concentrtions of were ssocited with prevlences Tble 2 Chrcteristics of the Study Popultion nd Climte Vribles in the Spnish ISAAC Centers (n=20 455) Vribles, No. (%) Age 6 yers (48.0%) 7 yers (52.0%) Sex Girls (50.2%) Boys (49.8%) Geogrphic re Mediterrnen Crtgen (13.3%) Vlenci (16.6%) Brcelon (14.2%) Centrl Spin Mdrid (11.5%) Atlntic Bilbo (14.9%) Asturis (14.8%) L Coruñ (14.8%) Born in Spin Yes (94.7%) No (5.3%) Eductionl level of mother Higher nd university eduction (30.5%) Medium-low nd no schooling (69.5%) Climte vribles Men nnul temperture Rnge Medin Men (SD) 13.9 C 20.2 C 14.6 C 16 C (2.3 C) Men nnul reltive humidity Rnge 59% 81% Medin 73% Men (SD) 71.8% (6.8%) Abbrevition: SD, stndrd devition. Dt re unvilble for some vlues. Tble 3 Men Annul Concentrtions of Air Pollutnts in the 7 Spnish ISAAC Centers in 2002, 24 h CO, 24 h NO 2, 24 h TSP, 24 h (μg/m 3 ) (μg/m 3 ) (μg/m 3 ) (μg/m 3 ) Minimum th percentile Medin th percentile Mximum Men (SD) 12.4 (4.6) 0.8 (0.2) 40.4 (18.8) 50.5 (7.5) Abbrevitions: CO, crbon monoxide; SD, stndrd devition; NO 2, nitrogen dioxide;, sulfur dioxide; TSP, totl suspended prticles. Centers in L Coruñ nd Mdrid, of rhinitis, rhinoconjunctivitis, recent severe sthm, nd nocturnl dry cough, with significnt djusted tendencies. In ll the prevlences of symptoms, except nocturnl dry cough, higher djusted OR were observed t higher levels of concentrtion; this is prticulrly cler in the cse of rhinoconjunctivitis (djusted OR between level-3 nd level-1 pollution [OR 3 1 ], 1.70; 95% CI, ), rhinitis (OR 3 1, 1.56; 95% CI, ), nd recent severe sthm (OR 3 1, 1.32; 95% CI, ). Higher men nnul concentrtions of CO were ssocited with higher prevlences of rhinitis (OR 3 1, 1.65; 95% CI, Document downloded from dy 31/12/2017. This copy is for personl use. Any trnsmission of this document by ny medi or formt is strictly prohibited. A. Arnedo-Pen et l / Arch Bronconeumol. 2009;45(5): Tble 4 Correltion Coefficients for the Men Annul Concentrtions of Air Pollutnts in the Spnish ISAAC Centers in ), rhinoconjunctivitis (OR 3 1, 1.76; 95% CI, ), nd topic eczem (OR 3 1, 1.55; 95% CI, ), lthough the tendency of this model did not show good fit (P=.0074). Associtions were not found between men nnul concentrtions of NO 2 nd the symptoms studied, except for nocturnl dry cough, for which the ssocition ws negtive. Although no ssocitions were found in the djusted tendencies, the levels with higher concentrtions of NO 2 hd higher ORs thn the lower levels for prevlences of rhinitis, wheezing, nd recent severe sthm. Men nnul concentrtions of TSP showed negtive ssocitions with rhinitis nd nocturnl dry cough, though the model for rhinitis did not show good fit in the Hosmer-Lemeshow goodness-of-fit test (χ 2 =19.55; P=.0122). The logistic regression models showed good fit in generl for ll symptoms, except the models for topic eczem nd concentrtions of CO, NO 2, nd TSP. Discussion CO NO 2 TSP 1.00 CO NO TSP Abbrevitions: CO, crbon monoxide; NO 2, nitrogen dioxide;, sulfur dioxide; TSP, totl suspended prticultes. Centers in L Coruñ nd Mdrid, Tble 5 Prevlence (%) of Recent Symptoms of Asthm, Allergic Rhinitis, nd Atopic Eczem in the Pst 12 Months in the Spnish ISAAC Centers in 2002 Wheezing Recent Nocturnl Rhinitis Rhinoconjunctivitis Eczem Severe Dry Asthm Cough Minimum th percentile Medin th percentile Mximum Centers in L Coruñ nd Mdrid, The results of this study indicte tht, in schoolchildren between the ges of 6 nd 7 yers, the higher the concentrtion of, the greter the risk of presenting rhinitis, rhinoconjunctivitis, nd recent severe sthm. In the centers with higher concentrtions of CO, the risk of symptoms of rhinitis nd rhinoconjunctivitis ws greter. Furthermore, higher concentrtions of NO 2 nd TSP were ssocited with lower risk of nocturnl dry cough. The link between concentrtions of nd its secondry compounds (cid erosols) nd the prevlence of bronchitis nd other respirtory symptoms in peditric popultions nd excerbtion of symptoms in sthmtic ptients is well known. 13 Recent studies in peditric popultions hve found ssocitions between the prevlence of llergic diseses nd concentrtions of this pollutnt in Polnd nd the Czech Republic, 14 Brzil, 15 Tiwn, 16 nd Frnce, 17 lthough this ssocition hs not been found in other studies. 18 In schoolchildren in Crtgen, 19 higher prevlence of topic dermtitis ws observed in the re of the city with higher concentrtions of nd TSP. Furthermore, n increse hs been reported in consulttions due to llergic rhinitis in ssocition with incresed concentrtions of. 20 The increses in recent symptoms ssocited with higher concentrtions of might be due to the effect of these concentrtions on the respirtory system, where they produce irrittion nd inflmmtion, thereby fcilitting the onset of the symptoms of llergic diseses; this could led to the increse in the prevlence of these diseses in the susceptible popultion. This gent my lso be n indictor of other ir pollutnts not included in this study. CO is not considered to hve ny effect t the concentrtions recorded in our study. 16 Nevertheless, higher prevlences
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