Longitudinal effects of air pollution on exhaled nitric oxide: the Children's Health Study

Occup Environ Med. 2014 Jul;71(7):507-13. doi: 10.1136/oemed-2013-101874. Epub 2014 Apr 2.


Objectives: To assess the effects of long-term variations in ambient air pollutants on longitudinal changes in exhaled nitric oxide (FeNO), a potentially useful biomarker of eosinophilic airway inflammation, based on data from the southern California Children's Health Study.

Methods: Based on a cohort of 1211 schoolchildren from eight Southern California communities with FeNO measurements in 2006-2007 and 2007-2008, regression models adjusted for short-term effects of air pollution were fitted to assess the association between changes in annual long-term exposures and changes in FeNO.

Results: Increases in annual average concentrations of 24-h average NO2 and PM2.5 (scaled to the IQR of 1.8 ppb and 2.4 μg/m(3), respectively) were associated with a 2.29 ppb (CI 0.36 to 4.21; p=0.02) and a 4.94 ppb (CI 1.44 to 8.47; p=0.005) increase in FeNO, respectively, after adjustments for short-term effects of the respective pollutants. In contrast, changes in annual averages of PM10 and O3 were not significantly associated with changes in FeNO. These findings did not differ significantly by asthma status.

Conclusions: Changes in annual average exposure to current levels of ambient air pollutants are significantly associated with changes in FeNO levels in children, independent of short-term exposures and asthma status. Use of this biomarker in population-based epidemiological research has great potential for assessing the impact of changing real world mixtures of ambient air pollutants on children's respiratory health.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Air Pollutants / adverse effects*
  • Air Pollution / adverse effects*
  • Asthma / metabolism*
  • Biomarkers / metabolism
  • California
  • Child
  • Child, Preschool
  • Environmental Exposure / adverse effects
  • Environmental Exposure / analysis
  • Environmental Monitoring
  • Eosinophils / metabolism
  • Exhalation
  • Female
  • Humans
  • Inflammation / chemically induced
  • Inflammation / metabolism
  • Iron Compounds / metabolism*
  • Longitudinal Studies
  • Male
  • Nitric Oxide* / adverse effects
  • Nitric Oxide* / metabolism
  • Particulate Matter / adverse effects*
  • Respiratory System / drug effects*
  • Respiratory System / metabolism


  • Air Pollutants
  • Biomarkers
  • Iron Compounds
  • Particulate Matter
  • Nitric Oxide