title: Effects of wintertime ambient air pollutants on asthma exacerbations in urban minority children with moderate to severe disease.
abstract: BACKGROUND
  Urban minority children with asthma are at higher risk for severe exacerbations leading to hospitalizations and deaths. Because multiple studies have reported associations between air pollution and asthma worsening, elevated levels of air pollution are cited as a possible trigger for increased asthma morbidity in urban areas. Few studies have prospectively followed panels of urban children with asthma to determine whether air pollution levels are associated with clinically relevant outcomes such as asthma exacerbations.
  
  
  OBJECTIVE
  To determine the association between levels of ambient air pollutants and asthma exacerbations in urban poor children with moderate to severe asthma.
  
  
  METHODS
  A school-based panel of children with difficult-to-control disease was followed over a period of 3 consecutive winters in Denver, Colo. The panel consisted of predominantly urban African American children with moderate to severe asthma. Levels of Environmental Protection Agency criteria air pollutants were measured on a daily basis with concurrent monitoring of lung function, bronchodilator use, symptoms, and asthma exacerbations.
  
  
  RESULTS
  After controlling for time-varying factors such as upper respiratory infections and meteorologic factors, a weak association was found between ambient carbon monoxide levels and bronchodilator use. Ozone levels were associated with daytime symptoms only. No association was observed between daily air pollution concentrations and daily levels of FEV 1 , peak flow, nighttime symptom scores, or asthma exacerbations over the 3-year period.
  
  
  CONCLUSIONS
  Ambient levels of Environmental Protection Agency criteria air pollutants in Denver do not lead to clinically significant asthma worsening in urban children with moderate to severe asthma during winter months when children are primarily indoors.
authors.affiliation: Division of Allergy/Immunology, Dept. of Pediatrics, National Jewish Medical and Research Center, 1400 Jackson Street, Denver, CO 80206, USA. rabinovitch@njc.org
authors.forename: Nathan
authors.initials: N
authors.lastname: Rabinovitch
authors.forename: Lening
authors.initials: L
authors.lastname: Zhang
authors.forename: James R
authors.initials: JR
authors.lastname: Murphy
authors.forename: Sverre
authors.initials: S
authors.lastname: Vedal
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Dutton
authors.forename: Erwin W
authors.initials: EW
authors.lastname: Gelfand
mesh_terms: D000393:Air Pollutants / Q000633:toxicity*; D000397:Air Pollution / Q000009:adverse effects; D001249:Asthma / Q000209:etiology*; D002648:Child; D003080:Cold Temperature; D006801:Humans; D008685:Meteorological Concepts; D014504:Urban Health
chemical_list: D000393:Air Pollutants