Published online March 2, 2009
PEDIATRICS Vol. 123 No. 3 March 2009, pp. 1051-1058 (doi:10.1542/peds.2008-1153)

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ARTICLE

Less Air Pollution Leads to Rapid Reduction of Airway Inflammation and Improved Airway Function in Asthmatic Children

Gabriele Renzetti, MD^a, Gaetano Silvestre, MD^a, Claudio D'Amario, MD^b, Egidio Bottini, MD^c, Fulvia Gloria-Bottini, MD^c, Nunzio Bottini, MD^d, Alexander Auais, MD^e, Miriam K. Perez, MD^f and Giovanni Piedimonte, MD^f

^a UOC Pediatria Medica, Pescara, Italy
^b Ospedale Civile Atri, Teramo, Italy
^c Department of Biopathology and Imaging Diagnostics, University of Rome Tor Vergata, Rome, Italy
^d Institute for Genetic Medicine, University of Southern California, Los Angeles, California
^e Genentech, Inc, San Francisco, California
^f Department of Pediatrics, West Virginia University, Morgantown, West Virginia

OBJECTIVE. Air pollution can promote airway inflammation, posing significant health risks for children with chronic respiratory problems. However, it is unknown whether this process is reversible, so that limiting pollution will benefit these children. We measured the short-term response of allergic asthmatic children exposed to a real-life reduction in outdoor air pollution by using noninvasive biomarkers of airway inflammation and function.

PATIENTS AND METHODS. Thirty-seven untreated allergic children with mild persistent asthma were recruited from a highly polluted urban environment and relocated to a less polluted rural environment. Air pollution, pollen counts, and meteorological conditions were carefully monitored at both sites. Nasal eosinophils, fractional exhaled nitric oxide, peak expiratory flow, and urinary leukotriene E₄ were measured first in the urban environment and then again 7 days after relocation to the rural environment.

RESULTS. One week after relocation to the rural environment, we measured, on average, a fourfold decrease in nasal eosinophils and significant decrease in fractional exhaled nitric oxide. We also noted an improvement in lower airway function, reflected by highly significant increase in peak expiratory flow. In contrast, mean urinary leukotriene E₄ concentration remained unchanged after 1 week of exposure to the rural environment.

CONCLUSIONS. Better air quality is associated with a rapid reduction of airway inflammation in allergic asthmatic children. Nasal eosinophils and fractional exhaled nitric oxide are sensitive indicators of this effect, and their rapid decline is paralleled by improved airway function measured by peak expiratory flow. Leukotriene synthesis has a more variable response to environmental modifications.

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Key Words: allergy • eosinophils • exhaled nitric oxide • leukotrienes • peak expiratory flow • rhinitis

Abbreviations: PM₁₀—particulate matter <10 µm in diameter • CO—carbon monoxide • PEF—peak expiratory flow • cysLT—cysteinyl leukotriene • LTE₄—leukotriene E₄ concentration • ARTA—Regional Agency for Environmental Protection • NO₂—nitrogen dioxide

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Accepted Jul 23, 2008.

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Air pollution does not influence eosinophils count in peripheral blood.

Giuseppe Lippi, et al.

Pediatrics Online, 14 Apr 2009 [Full text]