Asthma treatment response modified by fine particulate matter, nitrogen dioxide, and ozone among Black children: A reanalysis of the AsthmaNet Best African American Response to Asthma Drugs trial
Year: 2025
Type: article
Abstract: Background Asthma morbidity significantly affects children of all racial backgrounds; however, Black children experience a greater disease burden than children from other racial groups. Despite the known influence of air pollution on asthma outcomes, its role in the efficacy of asthma treatments remains underexplored. Objective We sought to examine how exposure to particulate matter <2.5 μm (PM 2.5 ), nitrogen dioxide (NO 2 ), and ozone (O 3 ) influenced treatment outcomes in the National Institutes of Health AsthmaNet Best African American Response to Asthma Drugs trial. Methods The trial randomized 224 Black children to 4 asthma treatments consisting of an inhaled corticosteroid (ICS) and long-acting β-agonist (LABA) administered in a randomized crossover fashion. Treatment efficacy was assessed by the frequency of asthma exacerbations, percent predicted FEV 1 , and annualized asthma control days. Residential exposures to PM 2.5 , NO 2 , and O 3 were estimated using a validated spatiotemporal model. Mixed-effects models were used to evaluate the interaction between pollution exposure and treatment efficacy, adjusting for age, household triggers, and trial site. Results PM 2.5 , NO 2 , and O 3 exposures ranged substantially across participants from 2.28 to 15.3 μg/m 3 , 2.34 to 63.7 ppm, and 2.57 to 23.7 ppb, respectively. NO 2 and PM 2.5 exposures were not associated with increased exacerbations post-treatment ( P for interaction=.15 and .08, respectively). However, NO 2 exposure significantly modified the effect of high-dose ICS+LABA therapy on lung function. Children with below median NO 2 exposures while receiving ICS+LABA therapy had a reduction of 5.86 (95% CI 1.16, 10.56) in percent predicted FEV 1 compared with children with above median NO 2 exposures. Conclusion Residential high NO 2 exposure may significantly attenuate the efficacy of ICS+LABA therapy on lung function in Black children. These findings suggest the need to consider environmental factors in clinical trials and asthma management strategies.
Authors: Lizbeth F. Gómez, Ellen J. Kinnee, Michael T. Young, Joel D. Kaufman, Anne M. Fitzpatrick, Sharmilee M. Nyenhuis, Julian Solway, Steven R. White, Edward T. Naureckas, Wanda Phipatanakul, Michael E. Wechsler, Susan J. Kunselman, David T. Mauger, Leslie A. McClure, Usama Bilal, Stephen C. Lazarus, Fernando Holguin, Jane E. Clougherty
Institutions: Drexel University, University of Pittsburgh, University of Washington, Emory University, University of Chicago, Boston Children's Hospital, National Jewish Health, Pennsylvania State University, Saint Louis University, University of California, San Francisco, University of Colorado Anschutz, University of Colorado Denver
Language: English
Subfield: Health, Toxicology and Mutagenesis
Field: Environmental Science
Domain: Physical Sciences
Open Access status: hybrid
Estimated APC paid: $4,900
Awards: G1399511062, G1593674991, G1902350037, G2533681692, G301003950, G3760622849, G435484807, AsthmaNet: Brigham and Women's Hospital & Children's Hospital Boston, G457819564, G5367028923, G5558259475, G7553154002, Data Coordinating Center for the NHLBI Asthma Network (AsthmaNet), ChicAgo Center for Health and EnvironmenT (CACHET)
OpenAlex ID: W4409464929