The Effect of Residential Endotoxin and Particulate Exposure on the Activity Levels of Asthmatic Children
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1 The Effect of Residential Endotoxin and Particulate Exposure on the Activity Levels of Asthmatic Children Hernando Perez, PhD, MPH, CIH Zekarias Berhane, PhD Patrick Gurian, PhD Terry Alexander Mariana Chilton, PhD, MPH Georgette Galbreth Virginius Bragg
2 Overview Purpose Background Methods Results Conclusions Limitations
3 Purpose
4 To evaluate the relationship between both dust endotoxin levels and airborne particlulate count concentrations in the residential environment and activity limitation in asthmatic children
5 Background
6 Particulates and Asthma Airborne particulate exposure can exacerbate asthma (Lipsett et al, 1997) Nygardet al (2004) Particle count and not mass best predicts ability to increase sensitization Penttinen et al (2001) Peak expiratory flow most closely associated with particle count (0.1 1 um)
7 Endotoxin and Asthma Significant associations have been observed in the residential environment in both children and adults (Michel et al, 1991, Michel et al, 1996; Rizzo et al, 1997) Exposure in infants associated with wheeze (Park et al, 2001, Bolte et al, 2003)
8 From: Oberdörster, G and M.J. Utell (2002) Ultrafine particles in the urban air: to the respiratory tract: and beyond. Environmental Health Perspectives 114:A440-A441
9 From: ICRP (1994). Annals of ICRP, Human Respiratory Tract Model for Radiological Protection. ICRP Publication 66, Pergamon (Oxford)
10 Method
11 Participants 115 parents or guardians of asthmatic children under the age of seven residing in Section 8 Housing in Philadelphia Goal to recruit minimum of 200 Phone recruitment through public housing roster information
12 Home visit Community Based Participatory Research (CBPR) model Surveys Visual Inspection Particle Sampling Dust Endotoxin Sample
13 Surveys Dietary Survey Not analyzed in this portion of the research Children s Health Survey for Asthma (CHSA) American Academy of Pediatrics Validated instrument (Asmussen et al, 1999) Five Domains Physical health (child), Activity (child and family), Emotional Health (child and family)
14 Visual Inspection Modified version of the EPA Asthma Home Environment Checklist (EPA 402 F ) followed as guide Intervention delivered during inspection
15 Particle and Dust Sampling Particle Fluke 983 Particle Counter (Fluke Corp., Everett, WA) Dust endotoxin 1 square foot of child sleeping surface 1 minute on a 25 mm endotoxin free polycarbonate filter loaded in three piece styrene cassette and maintained at approximately 4 o C until analysis using the Standard LAL Kinetic System (Cambrex Corp., East Rutherford, NJ).
16 Results
17 Sampling Summary Variable 0.3 um/liter 0.5 um/liter 1.0 um/liter 2.0 um/liter 5.0 um/liter 10.0 um/liter EU/mg GM (GSD) (7.11) 1200 (8.56) 152 (6.58) 100 (6.00) 14 (5.92) 4.3 (6.17) 1.3 (5.77)
18 Activity of Child Individual Regression Results Variable Temperature Humidity ln 0.3 um/liter ln 0.5 um/liter ln 1.0 um/liter ln 2.0 um/liter ln 5.0 um/liter ln 10.0 um/liter ln EU/g Beta P value
19 Activity of Child Backwards Regression Final Model Variables in Model Humidity Beta p value ln 0.3 um/liter ln 1.0 um/liter ln EU/g Overall p-value: 0.028
20 ln Endotoxin Individual Regression Results Variable Temperature Humidity ln 0.3 um /liter ln 0.5 um/liter ln 1.0 um/liter ln 2.0 um/liter ln 5.0 um/liter ln 10.0 um/liter Beta p value
21 ln Endotoxin Backwards Regression Final Model Variables Beta p value Temperature Humidity ln 0.3 um/liter Overall p-value for model: <0.001
22 Particulates and Gas Stoves Variable Mean without gas stove Mean with gas stove p value ln 0.3 um/liter ln 0.5 um/liter ln 1.0 um/liter ln 2.0 um/liter ln 5.0 um/liter ln10.0 um/liter ln EU /g
23
24 ln 0.3 um particles by location p-value: 0.010
25 ln 0.5 um particles by location p-value: 0.017
26 ln 1.0 um particles by location p-value: <0.106
27 ln 2.0 um particles by location p-value: 0.207
28 ln 5.0 um particles by location p-value: 0.063
29 ln >10 um particles by location p-value: 0.008
30 ln EU/g by location p-value: 0.059
31 ln 0.3 um particles by season p-value: <0.001 p-value: <0.001
32 ln 0.5 um particles by season p-value: <0.001
33 ln 1.0 um particles by season p-value: <0.001
34 ln 2.0 um particles by season p-value: <0.001
35 ln 5.0 um particles by season p-value: <0.001
36 ln >10 um particles by season p-value: <0.001
37 ln EU/g by season p-value: 0.105
38 Asthma Score by Location p-value: 0.622
39 Asthma Scores by Season p-value:0.679
40 Conclusions Reinforces evidence from other studies that smaller particles are most harmful Particulate size fraction may contain information that can help us distinguish between more and less harmful environments Endotoxin is most strongly associated with smaller particles but does not correlate with health in this cross sectional study Gas stoves appear to be an important source of indoor particulates Location effects may be strongest with the smallest particultes these are most subject to long range transport (hence outdoor influence) but more detailed analysis needed.
41 Limitations Cross sectional study may fail to identify effects of previous endotoxin exposures
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