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Original Research: Genetic and Developmental Disorders |

Ozone Is Associated With an Increased Risk of Respiratory Exacerbations in Patients With Cystic FibrosisOzone and Cystic Fibrosis

Sylvia C. L. Farhat, MD, PhD; Marina B. Almeida, MD, PhD; Luiz Vicente. R. F. Silva-Filho, MD, PhD; Juliana Farhat, MB; Joaquim C. Rodrigues, MD, PhD; Alfésio L. F. Braga, MD, PhD
Author and Funding Information

From the Emergency Unit (Dr Farhat), the Pulmonology Unit (Drs Almeida, Silva-Filho, and Rodrigues), Children’s Institute, Clinics Hospital and the Environmental Epidemiology Study Group (Drs Farhat and Braga and Ms Farhat), Laboratory of Experimental Air Pollution, University of São Paulo Medical School, São Paulo; the Virology Laboratory (Dr Silva-Filho), Tropical Medicine Institute, University of São Paulo, São Paulo; and Environmental Exposure and Risk Assessment (Dr Braga), Collective Health Post-graduation Program, Catholic University of Santos, Santos, Brazil.

Correspondence to: Sylvia C. L. Farhat, MD, PhD, Av Dr Eneas Carvalho Aguiar, 647 - Cerqueira César São Paulo – SP, Brazil, CEP 05403-000; e-mail: sylvia.farhat@gmail.com


For editorial comment see page 1093

Funding/Support: This study was supported by Fundação de Amparo à Pesquisa do Estado de São Paulo [Grant 05/01625-8].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(4):1186-1192. doi:10.1378/chest.12-2414
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Background:  Tropospheric oxidant pollutants may injure the respiratory tract. Cystic fibrosis (CF) respiratory disease involves significant inflammation and excessive oxidative stress, and exposure to air pollutants can magnify the lung damage. The objective of this study was to investigate the association between the short-term variation in the concentration of air pollutants in metropolitan São Paulo, Brazil, and the occurrence of respiratory exacerbations in children and adolescents with CF.

Methods:  A longitudinal panel of repeated measurements was obtained from 103 patients attending the outpatient center of our institution from September 6, 2006 through September 4, 2007. Daily concentrations of inhaled particulate matter, sulfur dioxide, nitrogen dioxide, ozone (O3), carbon monoxide, and meteorologic variables, such as the minimum temperature and relative humidity, were evaluated. The generalized estimation equation model for binomial distribution was used to assess the impact of these measurements on the occurrence of acute respiratory exacerbations.

Results:  In total, 103 patients with CF (median age, 8.9 years) made 408 visits, with a mean ± SD of 4 ± 1.74 visits per patient (range, 2-9). A respiratory disease exacerbation was diagnosed on 142 visits (38.4%). An interquartile range increase in the O3 concentration (45.62 μg/m3) had a positive, delayed (2 days after exposure) effect on the risk of a respiratory exacerbation (relative risk = 1.86; 95% CI, 1.14-3.02).

Conclusions:  This study demonstrates that exposure to short-term air pollution in a large urban center increases the risk of a pulmonary exacerbation in patients with CF.

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