A cross-sectional analysis of medical conditions and environmental factors associated with fractional exhaled nitric oxide (FeNO) in women and children from the ISA birth cohort, Costa Rica

• Published in: Environmental research Vol. 233; p. 116449
• Main Authors: Werthmann, Derek, van Wendel de Joode, Berna, Cuffney, Michael T., Reich, Brian J., Soto-Martinez, Manuel E., Corrales-Vargas, Andrea, Palomo-Cordero, Luis, Peñaloza-Castañeda, Jorge, Hoppin, Jane A.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 15.09.2023
• Subjects: Asthma - epidemiology; Asthma FeNO pesticides environment rhinitis wheeze; Birth Cohort; Breath Tests; Child; Costa Rica; Cross-Sectional Studies; Exhalation; Female; Fractional Exhaled Nitric Oxide Testing; Humans; Infant; Nitric Oxide - analysis; Pesticides; Rhinitis; Smoke - adverse effects; Costa Rica; FeNO; OR; ISA; CI; LMIC; Asthma FeNO pesticides environment rhinitis wheeze; BMI
• ISSN: 0013-9351; 1096-0953; 1096-0953
• DOI: 10.1016/j.envres.2023.116449

Fractional exhaled nitric oxide (FeNO) is a marker of airway inflammation. Elevated FeNO has been associated with environmental exposures, however, studies from tropical countries are limited. Using data from the Infants' Environmental Health Study (ISA) birth cohort, we evaluated medical conditions and environmental exposures’ association with elevated FeNO. We performed a cross-sectional analysis of 277 women and 293 8-year old children who participated in the 8-year post-partum visit in 2019. We measured FeNO and collected information on medical conditions and environmental exposures including smoke from waste burning, work in banana plantations, and home pesticide use. We defined elevated FeNO as >25 ppb for women and >20 ppb for children. To evaluate factors associated with elevated FeNO, we used logistic regression models adjusted for obesity in women and unadjusted in children. Overall elevated FeNO was common (20% of women, 13% of children). Rhinitis diagnosis was significantly associated with elevated FeNO in both women (odds ratio (OR): 3.67 95% Confidence Interval (CI): 1.81,7.35) and children (OR: 8.18 95%CI: 3.15, 21.22); wheeze was associated with elevated FeNO in women (OR: 4.50 95% CI: 2.25, 8.99). Environmental exposures were associated with elevated FeNO, but not significantly. Waste burning was associated with elevated FeNO in both women (OR: 1.58 95%CI 0.68, 4.15) and children (OR: 2.49 95%CI:0.82, 10.79). Para-occupational pesticide exposures were associated with elevated FeNO in women and children. For women, having a partner working in agriculture was associated with elevated FeNO (OR: 1.61 95%CI:0.77, 3.58) and for children, maternal work in agriculture was associated with elevated FeNO. (OR 2.08 95%CI 0.86, 4.67) Rhinitis and wheeze were associated with elevated FeNO in this rural, agricultural population. Smoke from waste burning as well as para-occupational pesticide exposure may contribute to elevated FeNO in rural communities. •Elevated FeNO is a non-specific marker of airway inflammation.•Rhinitis and wheeze were associated with elevated FeNO in Costa Rican women and children.•Waste burning and para-occupational pesticide exposure may contribute to elevated FeNO in rural communities.