Long-term ozone exposure and lung function in middle childhood

Abstract

Background: Ozone (O₃) exposure interrupts normal lung development in animal models. Epidemiologic evidence further suggests impairment with higher long-term O₃ exposure across early and middle childhood, although study findings to date are mixed and few have investigated vulnerable subgroups.

Methods: Participants from the CANDLE study, a pregnancy cohort in Shelby County, TN, in the ECHO-PATHWAYS Consortium, were included if children were born at gestational age >32 weeks, completed a spirometry exam at age 8-9, and had a valid residential history from birth to age 8. We estimated lifetime average ambient O₃ exposure based on each child's residential history from birth to age 8, using a validated fine-resolution spatiotemporal model. Spirometry was performed at the age 8-9 year study visit to assess Forced Expiratory Volume in the first second (FEV₁) and Forced Vital Capacity (FVC) as primary outcomes; z-scores were calculated using sex-and-age-specific reference equations. Linear regression with robust variance estimators was used to examine associations between O₃ exposure and continuous lung function z-scores, adjusted for child, sociodemographic, and home environmental factors. Potential susceptible subgroups were explored using a product term in the regression model to assess effect modification by child sex, history of bronchiolitis in infancy, and allergic sensitization.

Results: In our sample (n = 648), O₃ exposure averaged from birth to age 8 was modest (mean 26.6 [SD 1.1] ppb). No adverse associations between long-term postnatal O₃ exposure were observed with either FEV₁ (β = 0.12, 95% CI: -0.04, 0.29) or FVC (β = 0.03, 95% CI: -0.13, 0.19). No effect modification by child sex, history of bronchiolitis in infancy, or allergic sensitization was detected for associations with 8-year average O₃.

Conclusions: In this sample with low O₃ concentrations, we did not observe adverse associations between O₃ exposures averaged from birth to age 8 and lung function in middle childhood.

Keywords: FEV(1); FVC; Ozone; Spirometry.