title: Fine particulate matter exposure and initial Pseudomonas aeruginosa acquisition in cystic fibrosis.
abstract: BACKGROUND
  Increasing evidence suggests that exposure to ambient air pollution contributes to the severity of cystic fibrosis (CF) respiratory disease in school-age children and adults; however, the effects of air pollution on young children with CF are poorly understood.
  
  
  OBJECTIVE
  To investigate the association of exposure to fine particulate matter less than 2.5 μm in aerodynamic diameter (PM2.5) and initial Pseudomonas aeruginosa acquisition in young children with CF.
  
  
  METHODS
  Retrospective analysis of initial Pseudomonas acquisition in children 6 years of age or younger, using Cystic Fibrosis Foundation National Patient Registry data from 2003 to 2009. PM2.5 exposure was estimated by inverse distance weighting methods based on air pollution monitors within 30 miles of place of residence, for the year before the patient's birth. Multivariable Weibull regression with interval-censored outcomes was done to evaluate the association of time to initial Pseudomonas acquisition and PM2.5 concentrations.
  
  
  RESULTS
  A total of 3,575 children met inclusion criteria and 48% (n=1,711) acquired Pseudomonas at a median age of 15 months (25th-75th percentiles, 9-25 mo). An increase in PM2.5 exposure of 10 μg/m3 was associated with a 24% increased risk of Pseudomonas acquisition (95% confidence interval, 1-51%) during follow-up. Results were generally consistent across exposure metrics.
  
  
  CONCLUSIONS
  These results suggest that increased PM2.5 exposure is associated with earlier Pseudomonas acquisition in young children with CF and may play an important, previously unrecognized, role in the etiology of initial Pseudomonas infection.
authors.affiliation: 1 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Psoter
authors.forename: Anneclaire J
authors.initials: AJ
authors.lastname: De Roos
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Mayer
authors.forename: Joel D
authors.initials: JD
authors.lastname: Kaufman
authors.forename: Jon
authors.initials: J
authors.lastname: Wakefield
authors.forename: Margaret
authors.initials: M
authors.lastname: Rosenfeld
mesh_terms: D000328:Adult; D000397:Air Pollution / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000150:complications* / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009017:Morbidity / Q000639:trends; D052638:Particulate Matter / Q000009:adverse effects*; D011552:Pseudomonas Infections / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification*; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D052638:Particulate Matter
keywords: Pseudomonas aeruginosa; ambient air pollution; cystic fibrosis; epidemiology; fine particulate matter