title: Associations between air pollution and peak expiratory flow among patients with persistent asthma.
abstract: Responses of patients with persistent asthma to ambient air pollution may be different from those of general populations. For example, asthma medications may modify the effects of ambient air pollutants on peak expiratory flow (PEF). Few studies examined the association between air pollution and PEF in patients with persistent asthma on well-defined medication regimens using asthma clinical trial data. Airway obstruction effects of ambient air pollutants, using 14,919 person-days of daily self-measured peak expiratory flow (PEF), were assessed from 154 patients with persistent asthma during the 16 wk of active treatment in the Salmeterol Off Corticosteroids Study trial. The three therapies were an inhaled corticosteroid, an inhaled long-acting beta-agonist, and placebo. The participants were nonsmokers aged 12 through 63 yr, recruited from 6 university-based ambulatory care centers from February 1997 to January 1999. Air pollution data were derived from the U.S. Environmental Protection Agency Aerometric Information Retrieval System. An increase of 10 ppb of ambient daily mean concentrations of NO2 was associated with a decrease in PEF of 1.53 L/min (95% confidence interval [CI] -2.93 to -0.14) in models adjusted for age, gender, race/ethnicity, asthma clinical center, season, week, daily average temperature, and daily average relative humidity. The strongest association between NO2 and PEF was observed among the patients treated with salmeterol. Negative associations were also found between PEF and SO2 and between PEF and PM(10), respectively. The results show that the two medication regimens protected against the effects of PM(10). However, salmeterol increased the sensitivity to NO2 and triamcinalone enhanced the sensitivity to SO2.
authors.affiliation: Department of Public Health Sciences, Pennsylvania State University, Hershey, Pennsylvania, USA. zqian1@geisinger.edu
authors.forename: Zhengmin
authors.initials: Z
authors.lastname: Qian
authors.forename: Hung-Mo
authors.initials: HM
authors.lastname: Lin
authors.forename: Vernon M
authors.initials: VM
authors.lastname: Chinchilli
authors.forename: Erik B
authors.initials: EB
authors.lastname: Lehman
authors.forename: Walter F
authors.initials: WF
authors.lastname: Stewart
authors.forename: Nirav
authors.initials: N
authors.lastname: Shah
authors.forename: Yinkang
authors.initials: Y
authors.lastname: Duan
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Craig
authors.forename: William E
authors.initials: WE
authors.lastname: Wilson
authors.forename: Duanping
authors.initials: D
authors.lastname: Liao
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Lazarus
authors.forename: Rebecca
authors.initials: R
authors.lastname: Bascom
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000328:Adult; D000388:Air / Q000032:analysis; D000393:Air Pollutants / Q000009:adverse effects*; D000420:Albuterol / Q000031:analogs & derivatives / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy / Q000503:physiopathology*; D002648:Child; D004784:Environmental Monitoring; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000009:adverse effects / Q000032:analysis; D010366:Peak Expiratory Flow Rate / Q000187:drug effects; D000068299:Salmeterol Xinafoate; D013458:Sulfur Dioxide / Q000009:adverse effects / Q000032:analysis; D014221:Triamcinolone / Q000627:therapeutic use; D014504:Urban Health
chemical_list: D000318:Adrenergic beta-Agonists; D000393:Air Pollutants; D005938:Glucocorticoids; D013458:Sulfur Dioxide; D014221:Triamcinolone; D009569:Nitric Oxide; D000068299:Salmeterol Xinafoate; D000420:Albuterol