肥胖可能会增加城市学校NO2暴露对儿童哮喘症状的不利影响
2020/04/07
摘要
背景：市区学校中的二氧化氮（NO2）暴露对肥胖哮喘学生的影响研究数据较少。
目的：通过体质指数（BMI）进行分层，来评估教室NO2暴露与哮喘症状和发病率之间的关系。
方法：城市学校哮喘研究招募了来自37个城市学校的4-13岁患有哮喘的学生。对学生BMI百分位数进行基线测定。在随后的整个学年中监测哮喘症状，发病率，肺部炎症和肺功能。入组学生所在教室NO2每年检测两次。我们通过BMI进行人群分层，来明确教室NO2水平与哮喘结局之间的关系。
结果：分析中总共包括271人，主要为黑人（35％）和西班牙裔学生（35％）。正常体重占50％（BMI的5-84％），超重占15％（BMI的85-94％），肥胖占35％（BMI的≥95％）。每增加10 ppb的NO2，肥胖学生的有哮喘症状天数（OR = 1.86，95％置信区间[CI] = 1.15-3.02）和监护人更改计划天数（OR = 4.24，95％CI = 2.33-7.70）显著增加，而体重正常的学生NO2暴露与有症状天数（OR = 0.90，95％CI = 0.57-1.42，p = 0.03）和监护人改变天数（OR = 1.37，95％CI = 0.67-2.82，p = 0.02）无相关性。BMI分层下NO2水平与肺功能和FeNO之间的相关性无差异。若应用霍姆-邦费罗尼校正16个比较（肥胖对正常体重，超重对正常体重的各8个比较），则这些发现均无统计学意义（均p> 0.003）。
结论：肥胖可能会增加课堂NO2暴露对市区儿童哮喘症状的敏感性。对学校室内NO2 水平的干预措施可以改善肥胖儿童的哮喘状况。尽管经过多次比较调整后，我们的发现无统计学意义，但较大的效应值值得进一步研究儿童哮喘中肥胖与污染之间的相互作用。
Obesity May Enhance the Adverse Effects of NO2 Exposure in Urban Schools on Asthma Symptoms in Children.
Permaul P, Gaffin JM, Petty CR, Baxi SN, Lai PS, Sheehan WJ, Camargo CA Jr, Gold DR, Phipatanakul W.
Abstract
BACKGROUND:Sparse data address the effects of nitrogen dioxide (NO2) exposure in inner-city schools on obese students with asthma.
OBJECTIVE:To evaluate relationships between classroom NO2 exposure and asthma symptoms and morbidity by body mass index (BMI) category.
METHODS:The School Inner-City Asthma Study enrolled students aged 4-13 years with asthma from 37 inner-city schools. Students had baseline determination of BMI percentile. Asthma symptoms, morbidity, pulmonary inflammation and lung function were monitored throughout the subsequent academic year. Classroom NO2, linked to enrolled students, was collected twice per year. We determined the relationship between classroom NO2 levels and asthma outcomes by BMI stratification.
RESULTS:A total of 271 predominantly Black (35%) or Hispanic students (35%) were included in analyses. Fifty percent were normal weight (5-84th BMI percentile), 15% overweight (≥85-94th BMI percentile), and 35% obese (≥95th BMI percentile). For each 10 ppb increase in NO2, obese students had a significant increase in the odds of having an asthma symptom day (OR=1.86, 95% confidence interval [CI]=1.15-3.02) and in days caregiver changed plans (OR=4.24, 95% CI=2.33-7.70) which was significantly different than normal weight students who exhibited no relationship between NO2 exposure and symptom days (OR=0.90, 95% CI=0.57-1.42, pairwise interaction p=0.03) and change in caregiver plans (OR=1.37, 95% CI=0.67-2.82, pairwise interaction p=0.02). Relationships between NO2 levels and lung function and FENO did not differ by BMI category. If we applied a conservative Holm-Bonferroni correction for 16 comparisons (obese vs normal weight and overweight vs normal weight for 8 outcomes), these findings would not meet statistical significance (all p>0.003).
CONCLUSIONS:Obese BMI status appears to increase susceptibility to classroom NO2 exposure effects on asthma symptoms in inner-city children. Environmental interventions targeting indoor school NO2 levels may improve asthma health for obese children. Although our findings would not remain statistically significant after adjustment for multiple comparisons, the large effect sizes warrant future study of the interaction of obesity and pollution in pediatric asthma.
背景：市区学校中的二氧化氮（NO2）暴露对肥胖哮喘学生的影响研究数据较少。
目的：通过体质指数（BMI）进行分层，来评估教室NO2暴露与哮喘症状和发病率之间的关系。
方法：城市学校哮喘研究招募了来自37个城市学校的4-13岁患有哮喘的学生。对学生BMI百分位数进行基线测定。在随后的整个学年中监测哮喘症状，发病率，肺部炎症和肺功能。入组学生所在教室NO2每年检测两次。我们通过BMI进行人群分层，来明确教室NO2水平与哮喘结局之间的关系。
结果：分析中总共包括271人，主要为黑人（35％）和西班牙裔学生（35％）。正常体重占50％（BMI的5-84％），超重占15％（BMI的85-94％），肥胖占35％（BMI的≥95％）。每增加10 ppb的NO2，肥胖学生的有哮喘症状天数（OR = 1.86，95％置信区间[CI] = 1.15-3.02）和监护人更改计划天数（OR = 4.24，95％CI = 2.33-7.70）显著增加，而体重正常的学生NO2暴露与有症状天数（OR = 0.90，95％CI = 0.57-1.42，p = 0.03）和监护人改变天数（OR = 1.37，95％CI = 0.67-2.82，p = 0.02）无相关性。BMI分层下NO2水平与肺功能和FeNO之间的相关性无差异。若应用霍姆-邦费罗尼校正16个比较（肥胖对正常体重，超重对正常体重的各8个比较），则这些发现均无统计学意义（均p> 0.003）。
结论：肥胖可能会增加课堂NO2暴露对市区儿童哮喘症状的敏感性。对学校室内NO2 水平的干预措施可以改善肥胖儿童的哮喘状况。尽管经过多次比较调整后，我们的发现无统计学意义，但较大的效应值值得进一步研究儿童哮喘中肥胖与污染之间的相互作用。
(中日友好医院呼吸与危重症医学科 顾宪民 摘译 林江涛 审校)
(J Allergy Clin Immunol. 2020 Mar 17. pii: S0091-6749(20)30346-8. doi: 10.1016/j.jaci.2020.03.003.)
(J Allergy Clin Immunol. 2020 Mar 17. pii: S0091-6749(20)30346-8. doi: 10.1016/j.jaci.2020.03.003.)
Obesity May Enhance the Adverse Effects of NO2 Exposure in Urban Schools on Asthma Symptoms in Children.
Permaul P, Gaffin JM, Petty CR, Baxi SN, Lai PS, Sheehan WJ, Camargo CA Jr, Gold DR, Phipatanakul W.
Abstract
BACKGROUND:Sparse data address the effects of nitrogen dioxide (NO2) exposure in inner-city schools on obese students with asthma.
OBJECTIVE:To evaluate relationships between classroom NO2 exposure and asthma symptoms and morbidity by body mass index (BMI) category.
METHODS:The School Inner-City Asthma Study enrolled students aged 4-13 years with asthma from 37 inner-city schools. Students had baseline determination of BMI percentile. Asthma symptoms, morbidity, pulmonary inflammation and lung function were monitored throughout the subsequent academic year. Classroom NO2, linked to enrolled students, was collected twice per year. We determined the relationship between classroom NO2 levels and asthma outcomes by BMI stratification.
RESULTS:A total of 271 predominantly Black (35%) or Hispanic students (35%) were included in analyses. Fifty percent were normal weight (5-84th BMI percentile), 15% overweight (≥85-94th BMI percentile), and 35% obese (≥95th BMI percentile). For each 10 ppb increase in NO2, obese students had a significant increase in the odds of having an asthma symptom day (OR=1.86, 95% confidence interval [CI]=1.15-3.02) and in days caregiver changed plans (OR=4.24, 95% CI=2.33-7.70) which was significantly different than normal weight students who exhibited no relationship between NO2 exposure and symptom days (OR=0.90, 95% CI=0.57-1.42, pairwise interaction p=0.03) and change in caregiver plans (OR=1.37, 95% CI=0.67-2.82, pairwise interaction p=0.02). Relationships between NO2 levels and lung function and FENO did not differ by BMI category. If we applied a conservative Holm-Bonferroni correction for 16 comparisons (obese vs normal weight and overweight vs normal weight for 8 outcomes), these findings would not meet statistical significance (all p>0.003).
CONCLUSIONS:Obese BMI status appears to increase susceptibility to classroom NO2 exposure effects on asthma symptoms in inner-city children. Environmental interventions targeting indoor school NO2 levels may improve asthma health for obese children. Although our findings would not remain statistically significant after adjustment for multiple comparisons, the large effect sizes warrant future study of the interaction of obesity and pollution in pediatric asthma.
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