title: Health effects of indoor nitrogen dioxide and passive smoking on urban asthmatic children.
abstract: BACKGROUND
  Nitrogen dioxide (NO(2)) and environmental tobacco smoke (ETS) have been associated with adverse respiratory effects.
  
  
  OBJECTIVE
  We sought to assess the effect of NO(2) and ETS on asthma morbidity among children in inner-city environments.
  
  
  METHODS
  Asthmatic children between the ages of 4 and 9 years had exposure to NO(2) and ETS measured by using Palmes tubes in the home and urinary cotinine. A baseline interview and telephone assessments at 3, 6, and 9 months evaluated health service use, asthma symptoms, and peak flow rates.
  
  
  RESULTS
  Gas stoves were present in 87.8% of 469 homes. The median level of indoor NO(2) was 29.8 ppb compared with the US national outdoor median of 18 ppb. Of 1444 children, 48% had urinary cotinine/creatinine ratios of greater than 30 ng/mg. The median level of the cotinine/creatinine ratio was 42.4 ng/mg in smoking homes compared with 18.0 ng/mg in nonsmoking homes. The relative risk for asthma symptoms with increased NO(2) exposure was 1.75 (95% CI, 1.10-2.78) in children who did not have positive skin test responses. Higher NO(2) exposure resulted in lower peak flows during colder months (relative risk, 1.46; 95% CI, 1.07-1.97). Higher ETS exposure in colder months was weakly associated with lower peak flows (relative risk, 1.21; 95% CI, 0.99-1.47). There was no effect of ETS exposure on symptoms or use of health care services.
  
  
  CONCLUSIONS
  Higher levels of indoor NO(2) are associated with increased asthma symptoms in nonatopic children and decreased peak flows.
  
  
  CONCLUSIONS
  Interventions to reduce NO(2) exposure, such as venting of gas stoves, might help reduce asthma morbidity.
authors.affiliation: Department of Pediatrics, Mt Sinai School of Medicine, New York, NY, USA. meyer.kattan@mssm.edu
authors.forename: Meyer
authors.initials: M
authors.lastname: Kattan
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Gergen
authors.forename: Peyton
authors.initials: P
authors.lastname: Eggleston
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Visness
authors.forename: Herman E
authors.initials: HE
authors.lastname: Mitchell
mesh_terms: D016902:Air Pollution, Indoor / Q000009:adverse effects*; D001249:Asthma / Q000453:epidemiology* / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D003367:Cotinine / Q000652:urine; D006801:Humans; D009585:Nitrogen Dioxide / Q000009:adverse effects* / Q000032:analysis; D010366:Peak Expiratory Flow Rate; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*; D014504:Urban Health; D014505:Urban Population
chemical_list: D014028:Tobacco Smoke Pollution; D003367:Cotinine; D009585:Nitrogen Dioxide