Presence of asthma risk factors and environmental exposures related to upper respiratory infection-triggered wheezing in middle school-age children

Environ Health Perspect. 2003 Apr;111(4):657-62. doi: 10.1289/ehp.5824.


Viral respiratory infections and exposure to environmental constituents such as tobacco smoke are known or suspected to trigger wheezing/asthma exacerbations in children. However, few population-based data exist that examine the relationship between wheezing triggered by viral respiratory infections and environmental exposures. In this investigation we used population-based data to evaluate differences in exposures between symptomatic middle school-age children who did and did not report wheezing triggered by viral respiratory infections. As part of the North Carolina School Asthma Survey (NCSAS), a 66-question data instrument was used to collect information from children enrolled in North Carolina public middle schools during the 1999-2000 school year. Associations between exposures and upper respiratory infection-triggered wheezing (URI-TW) among symptomatic children were examined using adjusted prevalence odds ratios (PORs). Video methods developed for the International Study of Asthma and Allergies in Childhood were used to assess wheezing. Among the 33,534 NCSAS symptomatic participants, positive associations were observed between most exposures and URI-TW. Reported presence of all allergy variables (PORs ranging from 2.11 to 2.45) was more strongly associated with URI-TW than either smoking or other exposures. Presence of URI-TW was higher at increasing levels of tobacco smoke exposure, but no apparent dose-response effect was observed for other indoor air pollutants. URI-TW in middle school children is most associated with reported allergen sensitivity, relative to other asthma risk factors and environmental exposures. Data from this investigation may be useful in developing assessment, screening, and targeting strategies to improve asthma and wheezing management in children.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Asthma / epidemiology
  • Asthma / etiology*
  • Child
  • Environmental Exposure*
  • Female
  • Humans
  • Incidence
  • Male
  • North Carolina / epidemiology
  • Respiratory Sounds / etiology
  • Respiratory Tract Infections / etiology*
  • Respiratory Tract Infections / pathology
  • Respiratory Tract Infections / virology
  • Risk Factors
  • Severity of Illness Index
  • Virus Diseases / complications*