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All sourcesNASA NTRSDOE OSTI
DOE OSTI2020

Breathe Well, Live Well: Implementing an Adult Asthma Self-Management Education Program

Asthma remains a significant health problem in the United States. Adults with poorly controlled asthma can affect their community in a number of ways, from lost productivity in the workplace to health care costs to premature death. Asthma self-management education helps individuals achieve better control of their asthma and is critical for the overall health and well-being of individuals with asthma. While there are numerous programs and initiatives targeting children with asthma, there is a lack of comparable focus on the needs of adults with asthma. The American Lung Association developed Breathe Well, Live Well, an adult asthma self-management education program, and launched it nationwide in 2007. The program for adults has a flexible delivery format for community-based implementation. This article describes the development, dissemination, and transformation of the program. Each stage of implementation showed positive changes in asthma self-management practices that contribute to better asthma control, and one local implementation additionally showed decreased reports of missed work and unscheduled health care visits among participants. The findings from the three evaluations support the use of Breathe Well, Live Well for broad community-based implementation to improve asthma self-management efficacy and behaviors.

Gardner, Emily A.↗
DOE OSTI2022

Long-term trends in urban NO 2 concentrations and associated paediatric asthma incidence: estimates from global datasets

Combustion-related nitrogen dioxide (NO 2 ) air pollution is associated with paediatric asthma incidence. We aimed to estimate global surface NO 2 concentrations consistent with the Global Burden of Disease study for 1990-2019 at a 1 km resolution, and the concentrations and attributable paediatric asthma incidence trends in 13 189 cities from 2000 to 2019. We scaled an existing annual average NO 2 concentration dataset for 2010-12 from a land use regression model (based on 5220 NO 2 monitors in 58 countries and land use variables) to other years using NO 2 column densities from satellite and reanalysis datasets. We applied these concentrations in an epidemiologically derived concentration-response function with population and baseline asthma rates to estimate NO 2 -attributable paediatric asthma incidence. We estimated that 1.85 million (95% uncertainty interval [UI] 0.93-2.80 million) new paediatric asthma cases were attributable to NO 2 globally in 2019, two thirds of which occurred in urban areas (1.22 million cases; 95% UI 0.60-1.8 million). The proportion of paediatric asthma incidence that is attributable to NO 2 in urban areas declined from 19.8% (1.22 million attributable cases of 6.14 million total cases) in 2000 to 16.0% (1.24 million attributable cases of 7.73 million total cases) in 2019. Urban attributable fractions dropped in high-income countries (-41%), Latin America and the Caribbean (-16%), central Europe, eastern Europe, and central Asia (-13%), and southeast Asia, east Asia, and Oceania (-6%), and rose in south Asia (+23%), sub-Saharan Africa (+11%), and north Africa and the Middle East (+5%). The contribution of NO 2 concentrations, paediatric population size, and asthma incidence rates to the change in NO 2 -attributable paediatric asthma incidence differed regionally. Despite improvements in some regions, combustion-related NO 2 pollution continues to be an important contributor to paediatric asthma incidence globally, particularly in cities. Mitigating air pollution should be a crucial element of public health strategies for children.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2020

Association Between Changes in Timing of Spring Onset and Asthma Hospitalization in Maryland

The proposed association between climate change and increased burden of allergic diseases are based on three different thematic observational studies that have linked (i) increased CO 2 concentration with higher pollen production, (ii) warmer air/surface temperatures with early spring onset and longer pollen season, and (iii) higher pollen exposure with increased risk of asthma hospitalizations. Yet empirical evidence collectively linking climate change with pollen season and asthma exacerbation is still lacking. Using satellite observations, in situ pollen monitoring data, and hospitalization records (2001-2012), here we show that changes in the timing of spring onset resulting from ongoing climate variability and change is directly related to a longer tree pollen season and increased risk of asthma hospitalization. More specifically, we observed that very early start of season (SOS) to be associated with 10% increase in risk of asthma hospitalization (Incident Rate Ratio (IRR): 1.10, 95% Confidence Interval (CI): 1.02- 1.20) while late onset of SOS to be associated with 3% increase in risk of asthma hospitalization in Maryland (IRR: 1.03, 95% CI: 0.97-1.11), however the risk in the latter case was not statistically significant. Our results serve as a wake-up call to public health and medical communities regarding the need to anticipate and adapt to the ongoing changes in the timing and severity of the spring allergy season.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2026

Impact of Extreme Heat on Emergency Department Admissions for Childhood and Adult Asthma: An Evaluation of Earth Observations and Heat Wave Definitions

Extreme heat has been associated with adverse health outcomes, yet its impact on asthma exacerbations remains understudied. This is, in part, due to data limitations: research that relies on weather station records and aggregated health statistics cannot resolve fine-scale differences in heat impacts. This study investigates the association between heat wave definitions and summertime asthma-related emergency department visits in Baltimore, Maryland from 2016 to 2022, including 819 adult and 695 pediatric exacerbations. Using geocoded electronic health records and air temperature measurements at several spatial resolutions, we applied a case-crossover design with conditional logistic regressions at the census block group and tract levels. We found strong associations between asthma exacerbations and nighttime heat wave definitions based on relative thresholds of minimum temperatures when census block group or tract level temperature estimates were used. These relationships were significant for both age groups and showed elevated risks in socially vulnerable areas. In contrast, heat wave definitions derived from the city's primary National Weather Service synoptic weather station show associations between asthma and daytime heat extremes, suggesting that the character of the heat hazard depends on the scale at which it is defined. The extreme heat event definition used by Baltimore City's Code Red system showed no significant association with exacerbations. These findings highlight the importance of data resolution in shaping health inferences related to extreme heat in urban environments. Further, this study demonstrates that, regardless of spatial scale, extreme heat is associated with asthma exacerbations in both age groups.

Corpuz, B. [Johns Hopkins University, Baltimore, M↗
DOE OSTI2020

Inducible epithelial resistance against acute Sendai virus infection prevents chronic asthma‐like lung disease in mice

Background and Purpose Respiratory viral infections play central roles in the initiation, exacerbation and progression of asthma in humans. An acute paramyxoviral infection in mice can cause a chronic lung disease that resembles human asthma. We sought to determine whether reduction of Sendai virus lung burden in mice by stimulating innate immunity with aerosolized Toll‐like receptor (TLR) agonists could attenuate the severity of chronic asthma‐like lung disease. Experimental Approach Mice were treated by aerosol with 1‐μM oligodeoxynucleotide (ODN) M362, an agonist of the TLR9 homodimer, and 4‐μM Pam2CSK4 (Pam2), an agonist of the TLR2/6 heterodimer, within a few days before or after Sendai virus challenge. Key Results Treatment with ODN/Pam2 caused ~75% reduction in lung Sendai virus burden 5 days after challenge. The reduction in acute lung virus burden was associated with marked reductions 49 days after viral challenge in eosinophilic and lymphocytic lung inflammation, airway mucous metaplasia, lumenal mucus occlusion and hyperresponsiveness to methacholine. Mechanistically, ODN/Pam2 treatment attenuated the chronic asthma phenotype by suppressing IL‐33 production by type 2 pneumocytes, both by reducing the severity of acute infection and by down‐regulating Type 2 (allergic) inflammation. Conclusion and Implications These data suggest that treatment of susceptible human hosts with aerosolized ODN and Pam2 at the time of a respiratory viral infection might attenuate the severity of the acute infection and reduce initiation, exacerbation and progression of asthma.

Goldblatt, David L.↗
DOE OSTI2025

Neighborhood sociome factors and pediatric asthma exacerbations: Protective role of tree crown density and importance of pharmacy access in Chicago's south side

Abstract Background Pediatric asthma exacerbations remain a critical public health concern, particularly in historically underserved urban settings. Objective This study investigates sociome factors—the social context of disease—associated with asthma exacerbations among children living in Chicago's South Side, leveraging clinical and publicly available generalizable census tract‐level datasets from agencies including ChiVes, the City of Chicago Data Portal, EPA, Census Bureau, HUD, NOAA, and more. The aim is to uncover novel hypotheses for potential new interventions. Methods A generalized linear model assessed associations with the outcome of asthma exacerbations while accounting for clustering at the patient level. Predictors included all variables from the Sociome Data Commons, including social, environmental, behavioral, economic, housing, and school variables. Results Predictors of decreased risk included patient age (+4.8 years, −22%), tree crown density (+6% coverage, −17%), parks per acre (+0.41, −8%), and labor market engagement (+0.8 points, −9%). Conversely, predictors of increased risk included increased distance to the nearest pharmacy (+0.28 miles, +12%), limited English skills (+2.3%, +10%), higher inequality (+0.08 points, +8%), and visits in the Spring (+11%) and Fall (+20%). Conclusion The results suggest that tree crown density, a novel finding in the context of asthma exacerbations, may play a protective role. Limited access to health care facilities such as pharmacies continues to complicate care. Clinical Implications These findings provide hypotheses for future interventions for long‐standing asthma disparities.

Allergy↗
DOE OSTI2026

Measured Indoor Nitrogen Oxides in Homes with a Child with Asthma and Gas or Induction Electric Cooking

The Cooking Energy and Ventilation Impacts on Children's Asthma (CEVICA) study is a randomized control trial investigating the effects of replacing gas with induction electric ranges in the homes of children with asthma in California's San Joaquin Valley. Indoor air quality parameters and respiratory health indicators were measured over 2-week intensive at Baseline and after consecutive 3-month study phases, with half getting electric cooking at the start of Phase 1 and others in Phase 2. Indoor air measurements included time-integrated NO 2 and NO X by passive sampler and time-resolved NO 2 by electrochemical sensors. In the first 40 homes, data were collected during 61 intensives for gas cooking and 55 for induction. Cooking was identified using temperature sensors above the cooktop. Pollutant events were identified from sharp rises in concentrations Time integrated NOX species were lower with electric cooking, with mean differences of 14.2 ppb for NO 2 (95% CI: 9.6, 18.7; p < 0.001), 55.6 ppb for NO X (95% CI: 30.4, 80.9; p < 0.001), and 41.5 ppb for derived NO (95% CI: 19.7, 63.2; p < 0.001). A paired, within home analysis showed larger reductions in Group 2 (gas to induction) than Group 1 that remained electric across Phase 1 and Phase 2 for NO 2 (mean difference in As of 10.5 ppb; 95% CI: 5.6, 15.4; p < 0.001), NO X (32.3 ppb; 95% CI: 10.0, 54.5; p=0.007), and derived NO (21.8 ppb; 95% CI: 3.6, 40.0; p=0.022). Compared to electric cooking, gas had much higher rates of associated NO 2 events, and larger above-baseline NO 2 peaks. These preliminary results are consistent with prior findings that shifting to induction cooking can substantially lower indoor NO 2 compared with gas cooking.

Fang, Yi↗
DOE OSTI2022

Impact of acute temperature and air pollution exposures on adult lung function: A panel study of asthmatics

Background Individuals with respiratory conditions, such as asthma, are particularly susceptible to adverse health effects associated with higher levels of ambient air pollution and temperature. This study evaluates whether hourly levels of fine particulate matter (PM 2.5 ) and dry bulb globe temperature (DBGT) are associated with the lung function of adult participants with asthma. Methods and findings Global positioning system (GPS) location, respiratory function (measured as forced expiratory volume at 1 second (FEV 1 )), and self-reports of asthma medication usage and symptoms were collected as part of the Exposure, Location, and Lung Function (ELF) study. Hourly ambient PM 2.5 and DBGT exposures were estimated by integrating air quality and temperature public records with time-activity patterns using GPS coordinates for each participant (n = 35). The relationships between acute PM 2.5 , DBGT, rescue bronchodilator use, and lung function collected in one week periods and over two seasons (summer/winter) were analyzed by multivariate regression, using different exposure time frames. In separate models, increasing levels in PM 2.5 , but not DBGT, were associated with rescue bronchodilator use. Conversely DBGT, but not PM 2.5 , had a significant association with FEV 1 . When DBGT and PM 2.5 exposures were placed in the same model, the strongest association between cumulative PM 2.5 exposures and the use of rescue bronchodilator was identified at the 0–24 hours (OR = 1.030; 95% CI = 1.012–1.049; p-value = 0.001) and 0–48 hours (OR = 1.030; 95% CI = 1.013–1.057; p-value = 0.001) prior to lung function measure. Conversely, DBGT exposure at 0 hours (β = 3.257; SE = 0.879; p-value>0.001) and 0–6 hours (β = 2.885; SE = 0.903; p-value = 0.001) hours before a reading were associated with FEV 1 . No significant interactions between DBGT and PM 2.5 were observed for rescue bronchodilator use or FEV 1 . Conclusions Short-term increases in PM 2.5 were associated with increased rescue bronchodilator use, while DBGT was associated with higher lung function (i.e. FEV 1 ). Further studies are needed to continue to elucidate the mechanisms of acute exposure to PM 2.5 and DBGT on lung function in asthmatics.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2021

Incidence of chronic respiratory conditions among oil spill responders: Five years of follow-up in the Deepwater Horizon Oil Spill Coast Guard Cohort study

Background: Over ten years after the Deepwater Horizon (DWH) oil spill, our understanding of long term respiratory health risks associated with oil spill response exposures is limited. Here we conducted a prospective analysis in a cohort of U.S. Coast Guard personnel with universal military healthcare. Methods: For all active duty cohort members (N = 45,193) in the DWH Oil Spill Coast Guard Cohort Study we obtained medical encounter data from October 01, 2007 to September 30, 2015 (i.e., ~2.5 years pre-spill; ~5.5 years post-spill). We used Cox Proportional Hazards regressions to calculate adjusted hazard ratios (aHR), comparing risks for incident respiratory conditions/symptoms (2010–2015) for: responders vs. non-responders; responders reporting crude oil exposure, any inhalation of crude oil vapors, and being in the vicinity of burning crude oil versus responders without those exposures. We also evaluated self-reported crude oil and oil dispersant exposures, combined. Within-responder comparisons were adjusted for age, sex, and smoking. Results: While elevated aHRs for responder/non-responder comparisons were generally weak, within-responder comparisons showed stronger risks with exposure to crude oil. Notably, for responders reporting exposure to crude oil via inhalation, there were elevated risks for all sinusitis (aHR = 1.48; 95%CI, 1.06–2.06), unspecified chronic sinusitis (aHR = 1.55; 95%CI, 1.08–2.22), chronic obstructive pulmonary disease (COPD) and other allied conditions (aHR = 1.43; 95%CI, 1.00–2.06), and dyspnea and respiratory abnormalities (aHR = 1.29; 95%CI, 1.00–1.67); there was a suggestion of elevated risk for diseases classified as asthma and reactive airway diseases (aHR = 1.18; 95%CI, 0.98–1.41), including the specific condition, asthma (aHR = 1.35; 95%CI, 0.80–2.27), the symptom, shortness of breath (aHR = 1.50; 95%CI, 0.89–2.54), and the overall classification of chronic respiratory conditions (aHR = 1.18; 95%CI, 0.98–1.43). Exposure to both crude oil and dispersant was positively associated with elevated risk for shortness of breath (HR = 2.24; 95%CI, 1.09–4.64). Conclusions: Among active duty Coast Guard personnel, oil spill clean-up exposures were associated with moderately increased risk for longer term respiratory conditions.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2023

Natural gas odorants: A scoping review of health effects

Organosulfur compounds are intentionally added to natural gas as malodorants with the intent of short-term nasal inhalation to aid in leak detection. Regulatory exposure limits have not been established for all commonly used natural gas odorants, and recent community-level exposure events and growing evidence of indoor natural gas leakage have raised concerns associated with natural gas odorant exposures. We conducted a scoping review of peer-reviewed scientific publications on human exposures and animal toxicological studies of natural gas odorants to assess toxicological profiles, exposure potential, health effects and regulatory guidelines associated with commonly used natural gas odorants. We identified only 22 studies which met inclusion criteria for full review. Overall, there is limited evidence of both transient nonspecific health symptoms and clinically diagnosed causative neurotoxic effects associated with prolonged odorant exposures. Across seven community-level exposure events and two occupational case reports, consistent symptom patterns included: headache, ocular irritation, nose and throat irritation, respiratory complaints such as shortness of breath and asthma attacks, and skin irritation and rash. Of these, respiratory inflammation and asthma exacerbations are the most debilitating, whereas the high prevalence of ocular and dermatologic symptoms suggest a non-inhalation route of exposure. The limited evidence available raises the possibility that organosulfur odorants may pose health risks at exposures much lower than presently understood, though additional dose-response studies are needed to disentangle specific toxicologic effects from nonspecific responses to noxious organosulfur odors. Numerous recommendations are provided including more transparent and prescriptive natural gas odorant use practices.

63 RADIATION, THERMAL, AND OTHER ENVIRON. POLLUTAN↗
DOE OSTI2020

Association of residential energy efficiency retrofits with indoor environmental quality, comfort, and health: A review of empirical data

This paper reviews empirical data from evaluations of the influence of residential energy efficiency retrofits on indoor environmental quality conditions and self-reported thermal comfort and health. The data were extracted from 36 studies described in 44 papers plus two reports. Nearly all reviewed studies were performed in Europe or United States. Most studies evaluated retrofits of homes with low-income occupants. Indoor radon and formaldehyde concentrations tended to increase after retrofits that did not add whole-house mechanical ventilation. Study-average indoor concentrations of nitrogen dioxide and volatile organic compounds other than formaldehyde increased and decreased with approximately equal frequency. Average indoor temperatures during winter typically increased after retrofits, usually by less than 1.5 °C. Dampness and mold, usually based on occupant's reports, almost always decreased after retrofits. Subjectively reported thermal comfort, thermal discomfort, non-asthma respiratory symptoms, general health, and mental health nearly always improved after retrofits. For asthma symptoms, the evidence of improvement slightly outweighed the evidence of worsening. There was insufficient evidence to determine whether changes in thermal comfort and health outcomes varied depending on the type of energy efficiency retrofit. The published research has numerous limitations including a lack of data from retrofits in warm-humid climates and minimal data on changes in objective health outcomes. Suggestions for future research are provided.

32 ENERGY CONSERVATION, CONSUMPTION, AND UTILIZATI↗
DOE OSTI2021

Estimating the Acute Health Impacts of Fire-Originated PM 2.5 Exposure During the 2017 California Wildfires: Sensitivity to Choices of Inputs

Exposure to wildfire smoke increases the risk of respiratory and cardiovascular hospital admissions. Health impact assessments, used to inform decision-making processes, characterize the health impacts of environmental exposures by combining preexisting epidemiological concentration–response functions (CRFs) with estimates of exposure. These two key inputs influence the magnitude and uncertainty of the health impacts estimated, but for wildfire-related impact assessments the extent of their impact is largely unknown. We first estimated the number of respiratory, cardiovascular, and asthma hospital admissions attributable to fire-originated PM 2.5 exposure in central California during the October 2017 wildfires, using Monte Carlo simulations to quantify uncertainty with respect to the exposure and epidemiological inputs. We next conducted sensitivity analyses, comparing four estimates of fire-originated PM 2.5 and two CRFs, wildfire and nonwildfire specific, to understand their impact on the estimation of excess admissions and sources of uncertainty. We estimate the fires accounted for an excess 240 (95% CI: 114, 404) respiratory, 68 (95% CI: -10, 159) cardiovascular, and 45 (95% CI: 18, 81) asthma hospital admissions, with 56% of admissions occurring in the Bay Area. Although differences between impact assessment methods are not statistically significant, the admissions estimates' magnitude is particularly sensitive to the CRF specified while the uncertainty is most sensitive to estimates of fire-originated PM 2.5 . Not accounting for the exposure surface's uncertainty leads to an underestimation of the uncertainty of the health impacts estimated. Employing context-specific CRFs and using accurate exposure estimates that combine multiple data sets generates more certain estimates of the acute health impacts of wildfires.

58 GEOSCIENCES↗
DOE OSTI2026

Range Hood Use and Effectiveness in Reducing Indoor Air Pollution During Gas and Induction Cooking

The Cooking Energy and Ventilation Impacts on Children's Asthma (CEVICA) study measured cooking frequency, range hood use, indoor air quality and respiratory health indicators of children with asthma living in homes with gas stoves in California's San Joaquin Valley. The study installed electric induction stoves and repeated measurements over three 2-week intensive periods, at baseline and at the end of two consecutive 3-month study phases. Stove replacements occurred at the start of Phase 1 or Phase 2 by random assignment. There were 4184 cooking events identified by automated analysis of time-series data from temperature sensors mounted above the cooktops and 1038 related range hood usage events detected from data recorded by anemometers, smart plugs, or motor loggers. Analysis of 1-minute resolved PM2.5 and NO 2 data identified and quantified 2685 PM 2.5 events and 2606 NO 2 events. Range hood use was characterized as a binary variable (>3 min vs. <3 min use). Range hood use was more common during cooking events associated with particle emissions and longer cooking durations. PM 2.5 concentrations during events with range hood use were comparable to those without use, which could result from limited effectiveness or if range hoods were preferentially used during higher-emission cooking scenarios. In homes with gas cooking, integrated NO 2 concentrations were about 45 percent higher during cooking events with no range hood use compared to those range hood use. The lowest pollutant levels were observed when the range hood operated for more than half of the cooking duration. These findings show that operation of venting range hood during cooking can substantially reduce short-term indoor exposure NO 2 in homes with gas cooking.

Fang, Yi↗
DOE OSTI2026

Measured indoor PM2.5, black carbon, and oxidative potential before and after replacing gas with induction cooking in asthmatic households

Cooking is a major source of fine particulate matter (PM) in homes and evidence to date is inconclusive about the impact of cooking fuel on measures of residential PM exposure. The Cooking Energy and Ventilation Impacts on Children's Asthma (CEVICA) study measured cooking frequency, range hood use, indoor air quality (IAQ) and respiratory health indicators of children with asthma living in homes with gas stoves in California's San Joaquin Valley. Intensive measurements occurred over three 2-week intensive periods: at baseline and at the end of two consecutive 3-month study phases. Participants were randomly assigned to have their gas stoves replaced with electric induction at the start of Phase 1 or Phase 2. As part of the IAQ assessment, we collected particulate matter on Teflon filters using ultrasonic personal air samplers (UPAS). The filters were analyzed to quantify time-integrated PM 2.5 mass concentration, black carbon (BC) oxidative potential (OP). OP was measured using the SLF-OH assay, an acellular chemical assay that quantifies production of OH radicals in simulated lung fluid (SLF). Across all comparisons, PM 2.5 mass tended to be higher during gas cooking than induction electric cooking, although only one transition (Baseline to Phase 1) was statistically discernible at p<0.05. BC and mass-normalized OP showed no measurable differences across stove types or across phases. These preliminary findings suggest that stove fuel alone may not be the dominant determinant of indoor PM 2.5 concentrations in this sample, as previous studies have reported that indoor PM 2.5 during cooking can also be influenced by factors such as cooking practices, food and oil type, kitchen ventilation, and outdoor infiltration.

Lin, Zhuoying↗