Randomized trial of a portable HEPA air cleaner intervention to reduce asthma morbidity among Latino children in an agricultural community

Portable Air Cleaner Usage and Particulate Matter Exposure Reduction in an Environmental Justice Community: A Pilot Study

Particulate matter (PM) exposure is associated with adverse health outcomes, including respiratory illness. A large fraction of exposure to airborne contaminants occurs in the home. This study, conducted over 5 months in a community with high asthma rates (Chelsea, MA, USA), investigated the use of portable air cleaners (PACs) to reduce indoor PM. Seven asthma-affected households participated, receiving a PAC (Austin Air Health Mate HEPA filter), a QuantAQ sensor to measure PM1, PM2.5, PM10 (µg/m3), and a HOBO plug-load data logger to track PAC usage. Results describe hourly and daily PM concentrations and PAC usage for each household. Hourly average PM concentrations decreased when PACs were turned on (vs. when they were turned off) across households during the study period: PM1 decreased by 0.46 µg/m3, PM2.5 decreased by 0.69 µg/m3, and PM10 decreased by 3.22 µg/m3. PAC usage varied for each household, including constant usage in one household and only usage at certain times of day in others. Higher filtration settings led to lower PM, with significant reductions in some, but not all, homes. Our findings highlight some difficulties in implementing household PAC interventions, yet also provide evidence to support household-level interventions to reduce PM and other indoor sources of air pollution. We also highlight academic-community partnerships as contributing to evidence-based solutions.

PFAS in Nigeria: Identifying data gaps that hinder assessments of ecotoxicological and human health impacts

This review examines the extensive use and environmental consequences of Per- and Polyfluoroalkyl Substances (PFAS) on a global scale, specifically emphasizing their potential impact in Nigeria. Recognized for their resistance to water and oil, PFAS are under increased scrutiny for their persistent nature and possible ecotoxicological risks. Here, we consolidate existing knowledge on the ecological and human health effects of PFAS in Nigeria, focusing on their neurological effects and the risks they pose to immune system health. We seek to balance the advantages of PFAS with their potential ecological and health hazards, thereby enhancing understanding of PFAS management in Nigeria and advocating for more effective policy interventions and the creation of safer alternatives. The review concludes with several recommendations: strengthening regulatory frameworks, intensifying research into the ecological and health impacts of PFAS, developing new methodologies and longitudinal studies, fostering collaborative efforts for PFAS management, and promoting public awareness and education to support sustainable environmental practices and healthier communities in Nigeria.

Recent Insights into the Environmental Determinants of Childhood Asthma

PURPOSE OF REVIEW

Ubiquitous environmental exposures, including ambient air pollutants, are linked to the development and severity of childhood asthma. Advances in our understanding of these links have increasingly led to clinical interventions to reduce asthma morbidity.

RECENT FINDINGS

We review recent work untangling the complex relationship between air pollutants, including particulate matter, nitrogen dioxide, and ozone and asthma, such as vulnerable windows of pediatric exposure and their interaction with other factors influencing asthma development and severity. These have led to interventions to reduce air pollutant levels in children's homes and schools. We also highlight emerging environmental exposures increasingly associated with childhood asthma. Growing evidence supports the present threat of climate change to children with asthma. Environmental factors play a large role in the pathogenesis and persistence of pediatric asthma; in turn, this poses an opportunity to intervene to change the course of disease early in life.

Cross-sectional associations between neighborhood characteristics, cognition and dementia risk factor burden in middle-aged and older Australians

Dementia disproportionately affects individuals from disadvantaged backgrounds, including those living in areas of lower neighborhood-level socioeconomic status. It is important to understand whether there are specific neighborhood characteristics associated with dementia risk factors and cognition which may inform dementia risk reduction interventions. We sought to examine whether greenspace, walkability, and crime associated with the cumulative burden of modifiable dementia risk factors and cognition. This was a cross-sectional analysis of 2016-2020 data from the Healthy Brain Project, a population-based cohort of community-dwelling individuals across Australia. Participants were aged 40-70 and free of dementia. Measures included greenspace (greenspace % in the local area, and distance to greenspace, n = 2,181); and intersection density (n = 1,159), and crime (rate of recorded offences; n = 1,159). Outcomes included a modified Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) dementia risk score to index the burden of modifiable vascular dementia risk factors; and composite scores of both memory and attention, derived from the Cogstate Brief Battery. Linear regressions adjusted for age, sex, education, and personal socio-economic status, demonstrated distance to greenspace (b ± SE per 2-fold increase = 0.09 ± 0.03, p =.005) and crime rate (b ± SE per 2-fold increase = 0.07 ± 0.03, p =.018) were associated with higher modified CAIDE. Higher crime was associated with lower memory performance (b ± SE = -0.03 ± 0.01, p =.018). The association between distance to greenspace and modified CAIDE was only present in low-moderate socioeconomic status neighborhoods (p interaction = 0.004). Dementia prevention programs that address modifiable risk factors in midlife should consider the possible role of neighborhood characteristics.

Association of greenspaces exposure with cardiometabolic risk factors: a systematic review and meta-analysis

BACKGROUND

Cardiometabolic conditions are major contributors to the global burden of disease. An emerging body of evidence has associated access to and surrounding public open spaces (POS) and greenspace with cardiometabolic risk factors, including obesity, body mass index (BMI), hypertension (HTN), blood glucose (BG), and lipid profiles. This systematic review aimed to synthesize this evidence.

METHODS

This systematic review was conducted based on the PRISMA guidelines. Four electronic databases including Web of Science, PubMed, Scopus, and Google Scholar were searched for eligible articles published until July 2023. All observational studies which assessed the association of greenspace and POS with cardiometabolic risk factors including obesity, BMI, HTN, BG, and lipid profiles were included and reviewed by two authors independently. Heterogeneity between studies was assessed using the I2 index and Cochrane's Q test. Random/fixed effect meta-analyses were used to combine the association between greenspace exposure with cardiometabolic risk factors.

RESULTS

Overall, 118 relevant articles were included in our review. The majority of the articles were conducted in North America or Europe. In qualitative synthesis, access or proximity to greenspaces or POS impacts BMI and blood pressure or HTN, BG, and lipid profiles via various mechanisms. According to the random effect meta-analysis, more access to greenspace was significantly associated with lower odds of HTN (odds ratio (OR): 0.81, 95% confidence intervals (CIs): 0.61-0.99), obesity (OR: 0.83, 95% CIs: 0.77-0.90), and diabetes (OR:0.79, 95% CI: 0.67,0.90).

CONCLUSIONS

Findings of this systematic review and meta-analysis suggested that greenspace accessibility is associated with some cardiometabolic risk factors. Improving greenspace accessibility could be considered as one of the main strategies to reduce cardiometabolic risk factors at population level.

Self-reported health impacts of do-it-yourself air cleaner use in a smoke-impacted community

Background

Smoke exposure from wildfires or residential wood burning for heat is a public health problem for many communities. Do-It-Yourself (DIY) portable air cleaners (PACs) are promoted as affordable alternatives to commercial PACs, but evidence of their effect on health outcomes is limited.

Objective

Pilot test an evaluation of the effect of DIY PAC usage on self-reported symptoms, and investigate barriers and facilitators of PAC use, among members of a tribal community that routinely experiences elevated concentrations of fine particulate matter (PM2.5) from smoke.

Methods

We conducted studies in Fall 2021 ("wildfire study"; N = 10) and Winter 2022 ("wood stove study"; N = 17). Each study included four sequential one-to-two-week phases: 1) initial, 2) DIY PAC usage ≥8 h/day, 3) commercial PAC usage ≥8 h/day, and 4) air sensor with visual display and optional PAC use. We continuously monitored PAC usage and indoor/outdoor PM2.5 concentrations in homes. Concluding each phase, we conducted phone surveys about participants' symptoms, perceptions, and behaviors. We analyzed symptoms associated with PAC usage and conducted an analysis of indoor PM2.5 concentrations as a mediating pathway using mixed effects multivariate linear regression. We categorized perceptions related to PACs into barriers and facilitators of use.

Results

No association was observed between PAC usage and symptoms, and the mediation analysis did not indicate that small observed trends were attributable to changes in indoor PM2.5 concentrations. Small sample sizes hindered the ability to draw conclusions regarding the presence or absence of causal associations. DIY PAC usage was low; loud operating noise was a barrier to use.

Discussion

This research is novel in studying health effects of DIY PACs during wildfire and wood smoke exposures. Such research is needed to inform public health guidance. Recommendations for future studies on PAC use during smoke exposure include building flexibility of intervention timing into the study design.

A systematic review and meta-analysis of field studies of portable air cleaners: Performance, user behavior, and by-product emissions

Indoor air quality is important for the health of building occupants, and public interest in controlling indoor airborne pathogens increased dramatically with the COVID-19 pandemic. Pollutant concentrations can be controlled locally using portable air cleaners (sometimes called air purifiers), which allow occupants to apply air cleaning technology to meet their needs in the location and times that they find appropriate. This paper provides a systematic review of scientific literature that describes field studies of the effectiveness of portable air cleaners. Over 500 papers were considered, and 148 were reviewed in detail, to extract 35 specific research results (e.g., particulate removal performance) or characteristics (e.g., type of building). These were aggregated to provide an overview of results and approaches to this type of research, and to provide meta-analyses of the results. The review includes: descriptions of the geographical location of the research; rate of publications over time; types of buildings and occupants in the field study; types of air cleaner technology being tested; pollutants being measured; resulting pollutant removal effectiveness; patterns of usage and potential barriers to usage by occupants; and the potential for by-product emissions in some air cleaner technologies. An example result is that 83 of the 148 papers measured reductions in fine particulates (PM2.5) and found a mean reduction of 49 % with standard deviation of 20 %. The aggregated results were approximately normally distributed, ranging from finding no significant reduction up to a maximum above 90 % reduction. Sixteen of the 148 papers considered gaseous pollutants, such as volatile organic compounds, nitrogen dioxide, and ozone; 36 papers considered biological pollutants, such as bacteria, viruses, pollen, fungi, etc. An important challenge, common to several studies, is that occupants run the air cleaners for shorter periods and on low airflow rate settings, because of concerns about noise, drafts, and electricity cost, which significantly reduces air cleaning effectiveness.

Rapid weather changes are associated with daily hospital visitors for atrial fibrillation accompanied by abnormal ECG repolarization: a case-crossover study

BACKGROUND

Atrial fibrillation (AF) is highly prevalent in the population, yet the factors contributing to AF events in susceptible individuals remain partially understood. The potential relationship between meteorological factors and AF, particularly with abnormal electrocardiograph (ECG) repolarization, has not been adequately studied. This case-crossover study aims to investigate the association between meteorological factors and daily hospital visits for AF with abnormal ECG repolarization in Shanghai, China.

METHODS

The study cohort comprised 10,325 patients with ECG-confirmed AF who sought treatment at Shanghai Sixth People's Hospital between 2015 and 2018. Meteorological and air pollutant concentration data were matched with the patient records. Using a case-crossover design, we analyzed the association between meteorological factors and the daily count of hospital visitors for AF with abnormal ECG repolarization at our AF center. Lag analysis models were applied to examine the temporal relationship between meteorological factors and AF events.

RESULTS

The analysis revealed statistically significant associations between AF occurrence and specific meteorological factors. AF events were significantly associated with average atmospheric pressure (lag 0 day, OR 0.9901, 95% CI 0.9825-0.9977, P < 0.05), average temperature (lag 1 day, OR 0.9890, 95% CI 0.9789-0.9992, P < 0.05), daily pressure range (lag 7 days, OR 1.0195, 95% CI 1.0079-1.0312, P < 0.01), and daily temperature range (lag 5 days, OR 1.0208, 95% CI 1.0087-1.0331, P < 0.01). Moreover, a significant correlation was observed between daily pressure range and daily temperature range with AF patients, particularly those with abnormal ECG repolarization, as evident in the case-crossover analysis.

CONCLUSION

This study highlights a significant correlation between meteorological factors and daily hospital visits for AF accompanied by abnormal ECG repolarization in Shanghai, China. In addition, AF patients with abnormal ECG repolarization were found to be more vulnerable to rapid daily changes in pressure and temperature compared to AF patients without such repolarization abnormalities.

The mediating role of exhaled breath condensate metabolites in the effect of particulate matter on pulmonary function in schoolchildren: A crossover intervention study

The role played by metabolites in exhaled breath condensate (EBC) in the effect of PM on schoolchildren's pulmonary function has received little attention. Accordingly, we examined whether metabolites in EBC mediated the effect of PM10, PM2.5, and PM1 on the pulmonary function of schoolchildren at a residential primary school who had received an air-cleaner cross-over intervention. Samples of EBC were collected from a total of 60 schoolchildren and subjected to metabolomics analysis. We found that the effect of PM on six pulmonary function indicators was mediated by the following nine lipid peroxidation-related and energy metabolism-related metabolites present in EBC: 4-hydroxynonenal, arachidoyl ethanolamide, dl-pyroglutamic acid, 5-deoxy-d-glucose, myristic acid, lauric acid, linoleic acid, l-proline, and palmitic acid. However, while all nine of these metabolites mediated the effects of PM on boys' pulmonary function, only 4-hydroxynonenal, arachidoyl ethanolamide, and dl-pyroglutamic acid mediated the effects of PM on girls' pulmonary function. Overall, our results show that (1) short-term exposure to PM affected the schoolchildren's pulmonary function by causing an imbalance between lipid peroxidation and glutathione-based antioxidant activity and by perturbing energy metabolism in respiratory system and (2) there was a sex-dependent antioxidant response to PM exposure, with boys being less resistant than girls.

Associations between home environmental factors and childhood eczema and related symptoms in different cities in China

Previous studies have shown significant associations between home environmental factors and childhood eczema. However, few studies have compared how associations differ in different regions. This study investigated associations between home environmental factors and childhood eczema ever, and related symptoms including itchy rash (IR) and being awakened by itchy rash at night (awake by IR) in 4 cities located in different regions of China, based on cross-sectional investigations during 2010-2012. We used two-step analysis to explore the associations between influencing factors and eczema/related symptoms: first, group Least Absolute Shrinkage and Selection Operator (LASSO) was conducted to identify important factors among a list of candidates; then, the associations in total study population and in each city were estimated using logistic regression. We found these home environmental factors to be risk factors for eczema or related symptoms: large residence size, shared room, air cleaner at home, abnormal smell, perceived dry air, visible mold or damp stains, cooking with coal or wood, painted wall, incense, mice, new furniture during pregnancy, abnormal smell at birth, window condensation at birth and environmental tobacco smoke at birth. Environmental protective factors were rural house location and window ventilation. Associations of factors with eczema/related symptoms differed across cities. For example, air conditioning was protective for eczema in Beijing and awakening by IR in Shanghai with ORs of 0.70 (95%CI: 0.52, 0.95) and 0.33 (95%CI: 0.14, 0.81) respectively, but not significant in other cities. Our results have implications for improving home environments to reduce the risk of childhood eczema/related symptoms in different regions of China.

[Allergenic and chemical pollutants of indoor environments and asthma: Characterization, assessment and eviction]

The environment of an asthmatic patient can contain numerous sources of pollutants that degrade the quality of indoor air and have major repercussions on the occurrence and control of asthma. Assessment and improvement of the quality of indoor air should be assigned a major role in pneumology and allergology consultations. Characterization of an asthmatic's environment entails a search for biological pollutants with mite allergens, mildew, and allergens resulting from the proximity of pets. It is important to evaluate the chemical pollution represented by exposure to volatile organic compounds, which are increasingly present in our lodgings. Active or second-hand smoking must in all circumstances be sought out and quantified. Assessment of the environment is mediated by several methods, of which the application depends not only on the pollutant sought out, but also on enzyme-linked immunosorbent assay (ELISA), which has an essential role in quantification of biological pollutants. Attempts at expulsion of the different indoor environment pollutants is mediated by indoor environment advisors, whose efforts are aimed at obtaining reliable evaluation and control of indoor air. Implemented as a form of tertiary prevention, their methods are conducive to improved asthma control, in adults as well as children.

Socioeconomic and racial disparities in source-apportioned PM2.5 levels across urban areas in the contiguous US, 2010

Fine particulate matter (PM2.5) air pollution exposure is associated with short and long-term health effects. Several studies found differences in PM2.5 exposure associated with neighborhood racial and socioeconomic composition. However, most focused on total PM2.5 mass rather than its chemical components and their sources. In this study, we describe the ZIP code characteristics that drive the disparities in exposure to PM2.5 chemical components attributed to source categories both nationally and regionally. We obtained annual mean predictions of PM2.5 and fourteen of its chemical components from spatiotemporal models and socioeconomic and racial predictor variables from the 2010 US Census, and the American Community Survey 5-year estimates. We used non-negative matrix factorization to attribute the chemical components to five source categories. We fit generalized nonlinear models to assess the associations between the neighborhood predictors and each PM2.5 source category in urban areas in the United States in 2010 (n=25,790 zip codes). We observed higher PM2.5 levels in ZIP codes with higher proportions of Black individuals and lower socioeconomic status. Racial exposure disparities were mainly attributed to Heavy Fuel, Oil and Industrial, Metal Processing Industry and Agricultural, and Motor Vehicle sources. Economic disparities were mainly attributed to Soil and Crustal Dust, Heavy Fuel Oil and Industrial, Metal Processing Industry and Agricultural, and Motor Vehicle sources. Upon further analysis through stratifying by regions within the United States, we found that the associations between ZIP code characteristics and source-attributed PM2.5 levels were generally greater in Western states. In conclusion, racial, socioeconomic, and geographic inequalities in exposure to PM2.5 and its components are driven by systematic differences in component sources that can inform air quality improvement strategies.

Can individual protective measures safeguard cardiopulmonary health from air pollution? A systematic review and meta-analysis

Evidence supporting the effect of individual protective measures (IPMs) on air pollution is relatively scarce. In this study, we performed a systematic review and meta-analysis to investigate the effects of air purifiers, air-purifying respirators, and cookstove changes on cardiopulmonary health outcomes. We searched PubMed, Scopus, and Web of Science until December 31, 2022, 90 articles and 39,760 participants were included. Two authors independently searched and selected the studies, extracted information, and assessed each study's quality and risk of bias. We performed meta-analyses when three or more studies were available for each IPMs, with comparable intervention and health outcome. Systematic review showed that IPMs were beneficial in children and elderly with asthma along with healthy individuals. Meta-analysis results showed a reduction in cardiopulmonary inflammation using air purifiers than in control groups (with sham/no filter) with a decrease in interleukin 6 by -0.247 μg/mL (95% confidence intervals [CI] = -0.413, -0.082). A sub-group analysis for air purifier as an IPMs in developing counties reduced fractional exhaled nitric oxide by -0.208 ppb (95% confidence intervals [CI] = -0.394, -0.022). However, evidence describing the effects of air purifying respirator and cook stove changes on cardiopulmonary outcomes remained insufficient. Therefore, air purifiers can serve as efficient IPMs against air pollution. The beneficial effect of air purifiers is likely to have a greater effect in developing countries than in developed countries.

HEPA filtration intervention in classrooms may improve some students' asthma

OBJECTIVE

The School Inner-City Asthma Intervention Study 2 (SICAS 2) tested interventions to reduce exposures in classrooms of students with asthma. The objective of this post-hoc analysis was limited to evaluating the effect of high-efficiency particulate (HEPA) filtration interventions on mold levels as quantified using the Environmental Relative Moldiness Index (ERMI) and the possible improvement in the students' asthma, as quantified by spirometry testing.

METHODS

Pre-intervention dust samples were collected at the beginning of the school year from classrooms and corresponding homes of students with asthma (n = 150). Follow-up dust samples were collected in the classrooms at the end of the HEPA or Sham intervention. For each dust sample, ERMI values and the Group 1 and Group 2 mold levels (components of the ERMI metric) were quantified. In addition, each student's lung function was evaluated by spirometry testing, specifically the percentage predicted forced expiratory volume at 1 sec (FEV1%), before and at the end of the intervention.

RESULTS

For those students with a higher Group 1 mold level in their pre-intervention classroom than home (n = 94), the FEV1% results for those students was significantly (p < 0.05) inversely correlated with the Group 1 level in their classrooms. After the HEPA intervention, the average Group 1 and ERMI values were significantly lowered, and the average FEV1% test results significantly increased by an average of 4.22% for students in HEPA compared to Sham classrooms.

CONCLUSIONS

HEPA intervention in classrooms reduced Group 1 and ERMI values, which corresponded to improvements in the students' FEV1% test results.

Associations between repeated measures of urinary phthalate metabolites and biomarkers of oxidative stress in a rural agricultural cohort of children with asthma

Phthalate exposure is widespread, and studies suggest an adverse relationship with asthma morbidity, including some support for oxidative stress as an underlying pathophysiological mechanism. Urinary phthalate metabolites have been associated with biomarkers of oxidative stress, but data are few in children diagnosed with asthma. We used participant data from the Home Air in Agriculture Pediatric Intervention Trial (HAPI) to examine longitudinal relationships between phthalates and oxidative stress in a cohort of Latino children with asthma residing in an agricultural community. We used linear mixed-effects models to estimate associations between 11 urinary phthalate metabolites (and one summed measure of di-2-ethylhexyl phthalate (DEHP) metabolites, ∑DEHP) and two urinary biomarkers of oxidative stress: a biomarker of lipid peroxidation via measure of 8-isoprostane and a biomarker of DNA/RNA oxidative damage via combined measure of 8-hydroxydeoxyguanosine (8-OHdG), 8-hydroxyguanosine (8-OHG), and 8-hydroxyguanine. Seventy-nine participants provided 281 observations. In covariate-adjusted models, we observed significant positive relationships between all phthalate metabolites and 8-isoprostane, effect sizes ranging from a 9.3 % (95 % CI: 4.2 %-14.7 %) increase in 8-isoprostane for each 100 % increase (i.e., doubling) of mono-(carboxy-isooctyl) phthalate (MCIOP), to a 21.0 % (95 % CI: 14.3 %-28.2 %) increase in 8-isoprostane for each doubling of mono-n-butyl phthalate (MNBP). For each doubling of mono-(carboxy-isononyl) phthalate (MCINP) and mono-ethyl phthalate (MEP), the DNA/RNA oxidative damage biomarker increased by 6.0 % (95 % CI: 0.2 %-12.2 %) and 6.5 % (95 % CI: 1.4 %-11.9 %), respectively. In conclusion, we provide unique data suggesting phthalate exposure is positively associated with oxidative stress in children with asthma. Our repeat measures provide novel identification of a consistent effect of phthalates on oxidative stress in children with asthma via lipid peroxidation. Confirmation in future studies of children with asthma is needed to enhance understanding of the role of phthalates in childhood asthma morbidity.

Climatotherapy for asthma: Research progress and prospect

Asthma affects over 300 million people globally and is a cause of substantial burden of disease, including both premature death and reduced quality of life in people of all ages. Although both genetic and environmental factors play an important role in the pathogenesis of asthma, the rising trend of asthma and other allergic diseases over recent decades is thought to be largely caused by alteration in environmental conditions. Thus, a considerable amount of attention has been paid to environmental modification for the treatment and management of asthma, including household allergen reduction and/or irritant removal. More advanced environmental modification strategies (e.g., health resort medical rehabilitation, high-altitude climate therapy and multiple-hit interventions) have also been suggested. Research advances have been made over the past decades, but major challenges and opportunities coexist in this emerging field. Concerted efforts are required to tackle these formidable challenges.

Longitudinal measures of phthalate exposure and asthma exacerbation in a rural agricultural cohort of Latino children in Yakima Valley, Washington

Phthalates are a class of widely used synthetic chemicals found in commonly used materials and products. Epidemiological studies suggest phthalate exposure is associated with asthma outcomes, though most studies have not investigated phthalates as triggers of exacerbations in children diagnosed with asthma. This study used data from the Home Air in Agriculture Pediatric Intervention Trial (HAPI) to examine relationships between phthalate exposure and outcomes related to childhood asthma exacerbation. We used measures of phthalate metabolites and respiratory health measures including fractional exhaled nitric oxide (FENO), the Asthma Control Test (ACT), caregiver report of symptoms, and urinary leukotriene E₄ (uLTE₄) to estimate longitudinal associations using mixed effects models, adjusted for covariates. For 100% (i.e., doubling) increases in mono-(2-ethyl-5-carboxypentyl) phthalate (MECPP), mono-2-ethylhexyl phthalate (MEHP), and mono-ethyl phthalate (MEP), concentrations of FENO increased by 8.7% (95% CI: 0.7-17.3), 7.2% (95% CI: 0.0-14.9), and 6.4% (95% CI: 0.0-13.3), respectively. All phthalate metabolites demonstrated associations with uLTE₄, effect sizes ranging from an 8.7% increase in uLTE₄ (95% CI: 4.3-12.5) for a 100% increase in MEHP to an 18.1% increase in uLTE₄ (95% CI: 13.3-23.1) for a 100% increase in MNBP. In models of caregiver report of symptoms, no phthalate metabolites were significantly associated in primary models. No phthalate metabolites were associated with standardized ACT score. Our results suggest urinary phthalate metabolites are significant predictors of inflammatory biomarkers related to asthma exacerbation in children but not child and caregiver report of airway symptomatology.