Nasal oxidative stress mediating the effects of colder temperature exposure on pediatric asthma symptoms

Linchen He; Christina Norris; Kimberly Palaguachi-Lopez; Karoline Barkjohn; Zhen Li; Feng Li; Yinping Zhang; Marilyn Black; Michael H Bergin; Junfeng Jim Zhang

doi:10.1038/s41390-024-03196-2

Nasal oxidative stress mediating the effects of colder temperature exposure on pediatric asthma symptoms

Pediatr Res. 2024 Apr 11. doi: 10.1038/s41390-024-03196-2. Online ahead of print.

Authors

Linchen He¹, Christina Norris², Kimberly Palaguachi-Lopez³, Karoline Barkjohn^{4

5}, Zhen Li⁶, Feng Li⁷, Yinping Zhang^{8

9}, Marilyn Black¹⁰, Michael H Bergin⁴, Junfeng Jim Zhang^{11

12

13}

Affiliations

¹ Department of Community and Population Health, College of Health, Lehigh University, Bethlehem, PA, USA. lih322@lehigh.edu.
² Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
³ Department of Community and Population Health, College of Health, Lehigh University, Bethlehem, PA, USA.
⁴ Department of Civil and Environmental Engineering, Duke University, Durham, NC, USA.
⁵ Current Office of Research and Development, US Environmental Protection Agency, Research Triangle Park, Durham, NC, USA.
⁶ Department of Pediatrics, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China.
⁷ Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
⁸ Department of Building Science, Tsinghua University, Beijing, China.
⁹ Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Beijing, China.
¹⁰ Underwriters Laboratories, Inc, Marietta, GA, USA.
¹¹ Nicholas School of the Environment, Duke University, Durham, NC, USA. junfeng.zhang@duke.edu.
¹² Duke Global Health Institute, Duke University, Durham, NC, USA. junfeng.zhang@duke.edu.
¹³ Duke Kunshan University, Kunshan, Jiangsu, China. junfeng.zhang@duke.edu.

PMID: 38605092
DOI: 10.1038/s41390-024-03196-2

Abstract

Background: Colder temperature exposure is a known trigger for pediatric asthma exacerbation. The induction of oxidative stress is a known pathophysiologic pathway for asthma exacerbation. However, the role of oxidative stress in linking colder temperature exposure and worsened pediatric asthma symptoms is poorly understood.

Methods: In a panel study involving 43 children with asthma, aged 5-13 years old, each child was visited 4 times with a 2-week interval. At each visit, nasal fluid, urine, and saliva samples were obtained and measured for biomarkers of oxidative stress in the nasal cavity (nasal malondialdehyde [MDA]), the circulatory system (urinary MDA), and the oral cavity (salivary MDA). Childhood Asthma-Control Test (CACT) was used to assess asthma symptoms.

Results: When ambient daily-average temperature ranged from 7 to 18 °C, a 2 °C decrement in personal temperature exposures were significantly associated with higher nasal MDA and urinary MDA concentrations by 47-77% and 6-14%, respectively. We estimated that, of the decrease in child-reported CACT scores (indicating worsened asthma symptoms and asthma control) associated with colder temperature exposure, 14-57% were mediated by nasal MDA.

Conclusion: These results suggest a plausible pathway that colder temperature exposure worsens pediatric asthma symptoms partly via inducing nasal oxidative stress.

Impact: The role of oxidative stress in linking colder temperature exposure and worsened asthma symptoms is still poorly understood. Lower temperature exposure in a colder season was associated with higher nasal and systemic oxidative stress in children with asthma. Nasal MDA, a biomarker of nasal oxidative stress, mediated the associations between colder temperature exposures and pediatric asthma symptoms. The results firstly suggest a plausible pathway that colder temperature exposure worsens pediatric asthma symptoms partly via inducing oxidative stress in the nasal cavity.