Am. J. Respir. Crit. Care Med., Volume 157, Number 4, April 1998, 1034-1043

Acute Effects of Ambient Inhalable Particles in Asthmatic and Nonasthmatic Children

SVERRE VEDAL, JOHN PETKAU, RICK WHITE, and JIM BLAIR

Departments of Medicine and Statistics, University of British Columbia, and Vancouver Hospital and Health Sciences Centre, Vancouver, British Columbia, Canada

Although increases in inhalable particle (PM₁₀) concentrations have been associated with acute reductions in the level of lung function and increased symptom reporting in children, including children with asthma, it is not clear whether these effects occur largely in asthmatic children, or even whether asthmatic children are more likely to experience these effects than children without asthma. To address these points, the following subgroups of children were selected from a survey population of all 2,200 elementary school children (6 to 13 yr of age) in a pulp mill community on the west coast of Vancouver Island: (1) all children with physician-diagnosed asthma (n = 75 participated), (2) all children with an exercise-induced fall in FEV₁ without diagnosed asthma (n = 57), (3) all children with airway obstruction (FEV₁/FVC < 0.76) without either of the above (n = 18), and (4) control children without any of the above (n = 56). The children were followed for as long as 18 mo with twice daily measurements of peak expiratory flow (PEF) and daily symptom diary recording. Maximum daily PM₁₀ concentration was 159 µm/m³ (median, 22.1), but only 8 d (1.2%) had concentrations above 100 µg/m³. In an analysis that accounted for time-varying covariates, and serially correlated and missing data, for the entire sample of children, increases in PM₁₀ were associated with reductions in PEF and increased reporting of cough, phlegm production, and sore throat. For the subgroup of children with diagnosed asthma, PEF in the time period with the highest PM₁₀ concentrations fell by an estimated 0.55 L/min (95% CI, 0.06 to 1.05) for a 10 µg/m³ PM₁₀ increase above the mean daily PM₁₀ concentration of 27.3 µg/m³ and the odds of reported cough increased by 8% (95% CI, 0 to 16%); no consistent effects were observed in the other groups of children. It is concluded that children experience reductions in PEF and increased symptoms after increases in relatively low ambient PM₁₀ concentrations, and that children with diagnosed asthma are more susceptible to these effects than are other children.

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