Abstract
BACKGROUND: Indoor fine particulate air pollution (PM(2.5)) is linked to asthma morbidity; however, whether vitamin D status influences individual susceptibility to airborne exposures is unclear. OBJECTIVE: We aimed to determine if vitamin D modifies the effects of indoor PM(2.5) on asthma symptoms in urban children. METHODS: A total of 120 children aged 5 to 12 years with physician-diagnosed asthma were evaluated at baseline and every 3 months for 9 months. Indoor PM(2.5), serum 25-hydroxy vitamin D (25-OH D) levels, and asthma symptoms were simultaneously assessed at each time point. Adjusting for confounders, generalized estimating equations assessed the 3-way interaction effects of 25-OH D, obesity, and PM on asthma symptoms. RESULTS: Children were of mean (standard deviation [SD]) age 9.7 (2.2) years, 36% were obese, and 95% self-reported black race. Mean (SD) PM(2.5) indoor exposure was 38.2 (42.9) μg/m(3) and 25-OH D was 19.1 (7.5) ng/mL. Three-way interaction models demonstrated significantly greater PM(2.5)-associated effects on daytime asthma symptoms only among obese children with low 25-OH D levels (odds ratio [OR](PM2.5) = 1.26, P = .049 at vitamin D = 15.5 ng/mL, increasingly stronger PM effects at levels <15.5 ng/mL). In homes with increased PM(2.5), higher 25-OH D was associated with decreased symptom odds (eg, OR(Vitamin D) = 0.87; P = .049 at PM(2.5) = 52.5 μg/m(3), increasingly protective effects >52.5 μg/m(3)) among obese children. CONCLUSIONS: Among obese urban children with asthma, low individual 25-OH D enhanced adverse respiratory effects associated with indoor PM(2.5). In high PM(2.5) environments, 25-OH D was protective against asthma symptoms. Optimizing vitamin D status in children may help reduce asthma morbidity driven by indoor air pollution.