{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T15:47:17Z","timestamp":1789660037389,"version":"4.0.1"},"reference-count":49,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2022,3,17]],"date-time":"2022-03-17T00:00:00Z","timestamp":1647475200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute of Health","award":["U54 EB022002"],"award-info":[{"award-number":["U54 EB022002"]}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P30 ES007048"],"award-info":[{"award-number":["P30 ES007048"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Exposure to air pollution is associated with acute pediatric asthma exacerbations, including reduced lung function, rescue medication usage, and increased symptoms; however, most studies are limited in investigating longitudinal changes in these acute effects. This study aims to investigate the effects of daily air pollution exposure on acute pediatric asthma exacerbation risk using a repeated-measures design. Methods: We conducted a panel study of 40 children aged 8\u201316 years with moderate-to-severe asthma. We deployed the Biomedical REAI-Time Health Evaluation (BREATHE) Kit developed in the Los Angeles PRISMS Center to continuously monitor personal exposure to particulate matter of aerodynamic diameter &lt; 2.5 \u00b5m (PM2.5), relative humidity and temperature, geolocation (GPS), and asthma outcomes including lung function, medication use, and symptoms for 14 days. Hourly ambient (PM2.5, nitrogen dioxide (NO2), ozone (O3)) and traffic-related (nitrogen oxides (NOx) and PM2.5) air pollution exposures were modeled based on location. We used mixed-effects models to examine the association of same day and lagged (up to 2 days) exposures with daily changes in % predicted forced expiratory volume in 1 s (FEV1) and % predicted peak expiratory flow (PEF), count of rescue inhaler puffs, and symptoms. Results: Participants were on average 12.0 years old (range: 8.4\u201316.8) with mean (SD) morning %predicted FEV1 of 67.9% (17.3%) and PEF of 69.1% (18.4%) and 1.4 (3.5) puffs per day of rescue inhaler use. Participants reported chest tightness, wheeze, trouble breathing, and cough symptoms on 36.4%, 17.5%, 32.3%, and 42.9%, respectively (n = 217 person-days). One SD increase in previous day O3 exposure was associated with reduced morning (beta [95% CI]: \u22124.11 [\u22126.86, \u22121.36]), evening (\u22122.65 [\u22125.19, \u22120.10]) and daily average %predicted FEV1 (\u22123.45 [\u22126.42, \u22120.47]). Daily (lag 0) exposure to traffic-related PM2.5 exposure was associated with reduced morning %predicted PEF (\u22123.97 [\u22127.69, \u22120.26]) and greater odds of \u201cfeeling scared of trouble breathing\u201d symptom (odds ratio [95% CI]: 1.83 [1.03, 3.24]). Exposure to ambient O3, NOx, and NO was significantly associated with increased rescue inhaler use (rate ratio [95% CI]: O3 1.52 [1.02, 2.27], NOx 1.61 [1.23, 2.11], NO 1.80 [1.37, 2.35]). Conclusions: We found significant associations of air pollution exposure with lung function, rescue inhaler use, and \u201cfeeling scared of trouble breathing.\u201d Our study demonstrates the potential of informatics and wearable sensor technologies at collecting highly resolved, contextual, and personal exposure data for understanding acute pediatric asthma triggers.<\/jats:p>","DOI":"10.3390\/ijerph19063578","type":"journal-article","created":{"date-parts":[[2022,3,20]],"date-time":"2022-03-20T21:26:22Z","timestamp":1647811582000},"page":"3578","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Daily Associations of Air Pollution and Pediatric Asthma Risk Using the Biomedical REAI-Time Health Evaluation (BREATHE) Kit"],"prefix":"10.3390","volume":"19","author":[{"given":"Hua","family":"Hao","sequence":"first","affiliation":[{"name":"Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA 90039, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandrah P.","family":"Eckel","sequence":"additional","affiliation":[{"name":"Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA 90039, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anahita","family":"Hosseini","sequence":"additional","affiliation":[{"name":"Department of Computer Science, University of California Los Angeles, Los Angeles, CA 90095, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleanne D. S.","family":"Van Vliet","sequence":"additional","affiliation":[{"name":"Health Effects Institute, Boston, MA 02110, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eldin","family":"Dzubur","sequence":"additional","affiliation":[{"name":"Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA 90039, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Genevieve","family":"Dunton","sequence":"additional","affiliation":[{"name":"Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA 90039, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shih Ying","family":"Chang","sequence":"additional","affiliation":[{"name":"Sonoma Technology, Inc., Petaluma, CA 94954, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Craig","sequence":"additional","affiliation":[{"name":"Sonoma Technology, Inc., Petaluma, CA 94954, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rose","family":"Rocchio","sequence":"additional","affiliation":[{"name":"Mobilize Labs, University of California Los Angeles, Los Angeles, CA 90095, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresa","family":"Bastain","sequence":"additional","affiliation":[{"name":"Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA 90039, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Gilliland","sequence":"additional","affiliation":[{"name":"Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA 90039, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sande","family":"Okelo","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of California Los Angeles, Los Angeles, CA 90095, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7974-4309","authenticated-orcid":false,"given":"Mindy K.","family":"Ross","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of California Los Angeles, Los Angeles, CA 90095, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Majid","family":"Sarrafzadeh","sequence":"additional","affiliation":[{"name":"Department of Computer Science, University of California Los Angeles, Los Angeles, CA 90095, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex A. T.","family":"Bui","sequence":"additional","affiliation":[{"name":"Medical & Imaging Informatics Group, Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA 90095, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2103-1706","authenticated-orcid":false,"given":"Rima","family":"Habre","sequence":"additional","affiliation":[{"name":"Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA 90039, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,17]]},"reference":[{"key":"ref_1","unstructured":"(2021, September 13). CDC National Asthma Data, Available online: https:\/\/www.cdc.gov\/asthma\/most_recent_national_asthma_data.htm."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.1056\/NEJMc063596","article-title":"The asthma epidemic","volume":"356","author":"Kuschner","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1016\/j.rmed.2006.08.002","article-title":"Predictors of asthma control in children from different ethnic origins living in Amsterdam","volume":"101","author":"Stronks","year":"2007","journal-title":"Respir. Med."},{"key":"ref_4","first-page":"1","article-title":"Centers for Disease Control and Prevention; National Center for Health Statistics. The state of childhood asthma, United States, 1980\u20132005","volume":"381","author":"Akinbami","year":"2006","journal-title":"Adv. Data"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1378\/chest.110.6.1589","article-title":"Asthma: Better outcome at lower cost? The role of the expert in the care system","volume":"110","author":"Bartter","year":"1996","journal-title":"Chest"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1007\/BF00435966","article-title":"Measuring quality of life in the parents of children with asthma","volume":"5","author":"Juniper","year":"1996","journal-title":"Qual. Life Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e2021050286","DOI":"10.1542\/peds.2021-050286","article-title":"The 2020 Focused Updates to the NIH Asthma Management Guidelines: Key Points for Pediatricians","volume":"147","author":"Cloutier","year":"2021","journal-title":"Pediatrics"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"National Asthma Education and Prevention Program (2007). Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-Summary Report 2007. J. Allergy Clin. Immunol., 120, S94\u2013S138.","DOI":"10.1016\/j.jaci.2007.09.029"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/S0749-3797(02)00589-5","article-title":"Family history as a predictor of asthma risk","volume":"24","author":"Burke","year":"2003","journal-title":"Am. J. Prev. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1016\/S0140-6736(06)69286-6","article-title":"Perennial allergen sensitisation early in life and chronic asthma in children: A birth cohort study","volume":"368","author":"Illi","year":"2006","journal-title":"Lancet"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"m2791","DOI":"10.1136\/bmj.m2791","article-title":"Air pollution and family related determinants of asthma onset and persistent wheezing in children: Nationwide case-control study","volume":"370","author":"Holst","year":"2020","journal-title":"BMJ"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1164\/ajrccm.159.2.9712029","article-title":"Impaired airway function and wheezing in infancy: The influence of maternal smoking and a genetic predisposition to asthma","volume":"159","author":"Dezateux","year":"1999","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"S170","DOI":"10.1097\/01.inf.0000187273.47390.01","article-title":"Viral infections, cytokine dysregulation and the origins of childhood asthma and allergic diseases","volume":"24","author":"Friedlander","year":"2005","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1542\/peds.112.S1.233","article-title":"How environmental exposures influence the development and exacerbation of asthma","volume":"112","author":"Etzel","year":"2003","journal-title":"Pediatrics"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.aogh.2016.01.007","article-title":"The Impact of Early-Life Exposure to Air-borne Environmental Insults on the Function of the Airway Epithelium in Asthma","volume":"82","author":"Spann","year":"2016","journal-title":"Ann. Glob. Health"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1136\/archdischild-2017-312826","article-title":"Fine particulate pollution and asthma exacerbations","volume":"103","author":"Bouazza","year":"2018","journal-title":"Arch. Dis. Child."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1289\/ehp.6815","article-title":"Association of FEV1 in asthmatic children with personal and microenvironmental exposure to airborne particulate matter","volume":"112","author":"Delfino","year":"2004","journal-title":"Environ. Health Perspect."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"5246","DOI":"10.1073\/pnas.1805647115","article-title":"Short-term impact of PM2.5 on contemporaneous asthma medication use: Behavior and the value of pollution reductions","volume":"116","author":"Williams","year":"2019","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1038\/jes.2014.21","article-title":"The effects of PM2.5 and its components from indoor and outdoor sources on cough and wheeze symptoms in asthmatic children","volume":"24","author":"Habre","year":"2014","journal-title":"J. Expo. Sci. Environ. Epidemiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1093\/jamiaopen\/ooaa011","article-title":"Biomedical REAl-Time Health Evaluation (BREATHE): Toward an mHealth informatics platform","volume":"3","author":"Bui","year":"2020","journal-title":"JAMIA Open"},{"key":"ref_21","first-page":"725","article-title":"Changes in the normal maximal expiratory flow-volume curve with growth and aging","volume":"127","author":"Knudson","year":"1983","journal-title":"Am. Rev. Respir. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1177\/0009922816675013","article-title":"Asthma Control Test","volume":"56","author":"DuRivage","year":"2017","journal-title":"Clin. Pediatr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1175\/1520-0450(1996)035<0601:IMFAOS>2.0.CO;2","article-title":"Improved Magnus Form Approximation of Saturation Vapor Pressure","volume":"35","author":"Alduchov","year":"1996","journal-title":"J. Appl. Meterology Climatol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1016\/j.atmosenv.2013.05.074","article-title":"RLINE: A line source dispersion model for near-surface releases","volume":"77","author":"Snyder","year":"2013","journal-title":"Atmos. Environ."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1038\/jes.2016.32","article-title":"Is daily exposure to ozone associated with respiratory morbidity and lung function in a representative sample of schoolchildren? Results from a panel study in Greece","volume":"27","author":"Samoli","year":"2017","journal-title":"J. Expo. Sci. Environ. Epidemiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1097\/JOM.0000000000001011","article-title":"Effect of Ambient Ozone Exposure Assessed by Individual Monitors on Nasal Function and Exhaled NO Among School Children in the Area of Thessaloniki, Greece","volume":"59","author":"Angelis","year":"2017","journal-title":"J Occup. Environ. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1183\/09031936.00.16589300","article-title":"Effects of ambient ozone on lung function in children over a two-summer period","volume":"16","author":"Kopp","year":"2000","journal-title":"Eur. Respir. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.chemosphere.2011.11.048","article-title":"The short-term effects of air pollution on adolescent lung function in Taiwan","volume":"87","author":"Chang","year":"2012","journal-title":"Chemosphere"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1097\/01.ede.0000183166.68809.b0","article-title":"Chronic exposure to ambient ozone and lung function in young adults","volume":"16","author":"Tager","year":"2005","journal-title":"Epidemiology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1289\/ehp.00108265","article-title":"The Harvard Southern California Chronic Ozone Exposure Study: Assessing ozone exposure of grade-school-age children in two Southern California communities","volume":"108","author":"Geyh","year":"2000","journal-title":"Environ. Health Perspect."},{"key":"ref_31","unstructured":"World Health Organization (2013). Review of Evidence on Health Aspects of Air Pollution\u2014REVIHAAP Project: Technical Report, World Health Organization."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1093\/aje\/kwu115","article-title":"Who is more affected by ozone pollution? A systematic review and meta-analysis","volume":"180","author":"Bell","year":"2014","journal-title":"Am. J. Epidemiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1183\/09031936.00160806","article-title":"Effects of antioxidant enzyme polymorphisms on ozone-induced lung function changes","volume":"30","author":"Chen","year":"2007","journal-title":"Eur. Respir. J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1079\/PNS2004388","article-title":"Dietary antioxidants and environmental stress","volume":"63","author":"Kelly","year":"2004","journal-title":"Proc. Nutr. Soc."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0098-2997(00)00003-0","article-title":"Ozone and the lung: A sensitive issue","volume":"21","author":"Mudway","year":"2000","journal-title":"Mol. Asp. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1080\/00039890109604069","article-title":"Traffic-related air pollution affects peak expiratory flow, exhaled nitric oxide, and inflammatory nasal markers","volume":"56","author":"Steerenberg","year":"2001","journal-title":"Arch. Environ. Health"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1016\/j.chest.2021.07.2170","article-title":"Systematic Review of Ozone Effects on Human Lung Function, 2013 Through 2020","volume":"161","author":"Holm","year":"2022","journal-title":"Chest"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1080\/10962247.2014.991856","article-title":"Emissions reduction policies and recent trends in Southern California\u2019s ambient air quality","volume":"65","author":"Lurmann","year":"2015","journal-title":"J. Air Waste Manag. Assoc."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"895","DOI":"10.3109\/02770903.2012.724129","article-title":"Panel studies of air pollution on children\u2019s lung function and respiratory symptoms: A literature review","volume":"49","author":"Li","year":"2012","journal-title":"J. Asthma"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1080\/10590500802494538","article-title":"Airborne particulate matter and human health: Toxicological assessment and importance of size and composition of particles for oxidative damage and carcinogenic mechanisms","volume":"26","author":"Valavanidis","year":"2008","journal-title":"J. Environ. Sci. Health C Environ. Carcinog. Ecotoxicol. Rev."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"8852","DOI":"10.1016\/j.atmosenv.2008.09.011","article-title":"Chemical characteristics of fine particles emitted from different gas cooking methods","volume":"42","author":"See","year":"2008","journal-title":"Atmos. Environ."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1093\/aje\/kwj225","article-title":"Ambient air pollution and asthma exacerbations in children: An eight-city analysis","volume":"164","author":"Schildcrout","year":"2006","journal-title":"Am. J. Epidemiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"105331","DOI":"10.1016\/j.envint.2019.105331","article-title":"Geospatial-temporal analysis of the impact of ozone on asthma rescue inhaler use","volume":"136","author":"Pepper","year":"2020","journal-title":"Environ. Int."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.1016\/S0140-6736(14)60617-6","article-title":"Outdoor air pollution and asthma","volume":"383","author":"Guarnieri","year":"2014","journal-title":"Lancet"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1080\/08958370490506646","article-title":"An analysis of the association between respiratory symptoms in subjects with asthma and daily air pollution in Spokane, Washington","volume":"16","author":"Mar","year":"2004","journal-title":"Inhal. Toxicol."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Esposito, S., Galeone, C., Lelii, M., Longhi, B., Ascolese, B., Senatore, L., Prada, E., Montinaro, V., Malerba, S., and Patria, M.F. (2014). Impact of air pollution on respiratory diseases in children with recurrent wheezing or asthma. BMC Pulm. Med., 14.","DOI":"10.1186\/1471-2466-14-130"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1164\/ajrccm.156.2.9608044","article-title":"Air pollution and respiratory health among children with asthmatic or cough symptoms","volume":"156","author":"Timonen","year":"1997","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/S0013-9351(03)00038-0","article-title":"Acute effects of urban ambient air pollution on respiratory symptoms, asthma medication use, and doctor visits for asthma in a cohort of Australian children","volume":"95","author":"Jalaludin","year":"2004","journal-title":"Environ. Res."},{"key":"ref_49","first-page":"100031","article-title":"Deliberating performance targets workshop: Potential paths for emerging PM2.5 and O3 air sensor progress","volume":"2","author":"Williams","year":"2019","journal-title":"Atmos. Environ. X"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/6\/3578\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:38:25Z","timestamp":1760135905000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/6\/3578"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,17]]},"references-count":49,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,3]]}},"alternative-id":["ijerph19063578"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19063578","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,17]]}}}