title: Household levels of nitrogen dioxide and pediatric asthma severity.
abstract: BACKGROUND
  Adverse respiratory effects in children with asthma are associated with exposures to nitrogen dioxide (NO2). Levels indoors can be much higher than outdoors. Primary indoor sources of NO2 are gas stoves, which are used for cooking by one-third of U.S. households. We investigated the effects of indoor NO2 exposure on asthma severity among an ethnically and economically diverse sample of children, controlling for season and indoor allergen exposure.
  
  
  METHODS
  Children 5-10 years of age with active asthma (n = 1,342) were recruited through schools in urban and suburban Connecticut and Massachusetts (2006-2009) for a prospective, year-long study with seasonal measurements of NO2 and asthma severity. Exposure to NO2 was measured passively for four, month-long, periods with Palmes tubes. Asthma morbidity was concurrently measured by a severity score and frequency of wheeze, night symptoms, and use of rescue medication. We used adjusted, hierarchical ordered logistic regression models to examine associations between household NO2 exposure and health outcomes.
  
  
  RESULTS
  Every 5-fold increase in NO2 exposure above a threshold of 6 ppb was associated with a dose-dependent increase in risk of higher asthma severity score (odds ratio = 1.37 [95% confidence interval = 1.01-1.89]), wheeze (1.49 [1.09-2.03]), night symptoms (1.52 [1.16-2.00]), and rescue medication use (1.78 [1.33-2.38]).
  
  
  CONCLUSIONS
  Asthmatic children exposed to NO2 indoors, at levels well below the U.S. Environmental Protection Agency outdoor standard (53 ppb), are at risk for increased asthma morbidity. Risks are not confined to inner city children, but occur at NO2 concentrations common in urban and suburban homes.
authors: Center for Perinatal, Pediatric and Environmental Epidemiology, Yale University School of Public Health, New Haven, CT 06510, USA.
authors: Kathleen
authors: K
authors: Belanger
authors: Theodore R
authors: TR
authors: Holford
authors: Janneane F
authors: JF
authors: Gent
authors: Melissa E
authors: ME
authors: Hill
authors: Julie M
authors: JM
authors: Kezik
authors: Brian P
authors: BP
authors: Leaderer
mesh_terms: D016902:Air Pollution, Indoor / Q000009:adverse effects* / Q000032:analysis; D001249:Asthma / Q000139:chemically induced / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D004781:Environmental Exposure / Q000009:adverse effects* / Q000032:analysis; D004784:Environmental Monitoring / Q000379:methods; D005191:Family Characteristics; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000175:diagnosis; D016015:Logistic Models; D008297:Male; D009585:Nitrogen Dioxide / Q000009:adverse effects*; D011446:Prospective Studies; D012621:Seasons; D012720:Severity of Illness Index
chemical_list: D009585:Nitrogen Dioxide