title: The relationship between low level nitrogen dioxide exposure and child lung function after cold air challenge.
abstract: BACKGROUND
  Nitrogen dioxide (NO(2)) or home gas appliance use has been inconsistently associated with adverse respiratory outcomes in childhood.
  
  
  OBJECTIVE
  (i) To examine the contribution of home gas appliance type and personal NO(2) exposure. (ii) To examine the relationship between NO(2) exposure and child lung function and respiratory history. (iii) To assess whether these relationships vary by house dust mite sensitization status.
  
  
  METHODS
  A cross-sectional survey of 344 children (71% of the eligible group) with a mean age of 9.1 years from four randomly selected schools in the Australian Capital Territory from July to September 1999. Study measurements included a parental questionnaire, NO(2) exposure by passive gas samplers, skin prick testing for 10 aeroallergens and lung function at rest and after cold air challenge.
  
  
  RESULTS
  Total NO(2) exposure was low with a mean concentration of 10.1 ppb. No associations were found between NO(2) exposure or gas appliance use and asthma, wheeze or baseline lung function. Personal NO(2) exposure was associated with a reduction in forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) after cold air challenge (adjusted difference - 0.12% (- 0.23% to - 0.01%) per 1 ppb increase). After exclusion of children who had home heating changed because of asthma, gas heater use was also significantly associated with a reduction in this measure (adjusted difference - 2.0% (- 3.7% to - 0.2%)). There was some evidence that these reductions were greater among the non-mite-sensitized children.
  
  
  CONCLUSIONS
  The effect of low-level NO(2) exposure on these respiratory outcomes was not marked. The possible effect of low-level NO(2) exposure on non-specific bronchial reactivity requires confirmation. Future studies on NO(2) and respiratory health should include measures of house dust mite sensitization and bronchial hyper-responsiveness.
authors.affiliation: Academic Unit of General Practice and Community Care, Canberra Clinical School, University of Sydney, Jamison Centre, Canberra, Australia. anne-louise.ponsonby@calvary-act.com.au
authors.forename: A L
authors.initials: AL
authors.lastname: Ponsonby
authors.forename: N
authors.initials: N
authors.lastname: Glasgow
authors.forename: P
authors.initials: P
authors.lastname: Gatenby
authors.forename: R
authors.initials: R
authors.lastname: Mullins
authors.forename: T
authors.initials: T
authors.lastname: McDonald
authors.forename: M
authors.initials: M
authors.lastname: Hurwitz
authors.forename: B
authors.initials: B
authors.lastname: Pradith
authors.forename: R
authors.initials: R
authors.lastname: Attewell
mesh_terms: D000388:Air / Q000032:analysis; D016902:Air Pollution, Indoor / Q000009:adverse effects / Q000032:analysis; D000485:Allergens / Q000009:adverse effects / Q000276:immunology; D000818:Animals; D039741:Antigens, Dermatophagoides; D002648:Child; D003080:Cold Temperature / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D004306:Dose-Response Relationship, Immunologic; D006023:Glycoproteins / Q000009:adverse effects / Q000276:immunology; D006361:Heating / Q000009:adverse effects / Q000379:methods; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000276:immunology / Q000503:physiopathology; D008168:Lung / Q000503:physiopathology*; D008925:Mites / Q000276:immunology; D009585:Nitrogen Dioxide / Q000009:adverse effects* / Q000378:metabolism; D012129:Respiratory Function Tests; D012307:Risk Factors
chemical_list: D000485:Allergens; D039741:Antigens, Dermatophagoides; D006023:Glycoproteins; D009585:Nitrogen Dioxide