Precipitation and Adolescent Respiratory Health in the Northeast United States

Rationale: With more frequent and intense precipitation events across the globe due to a changing climate, there is a need to understand the relationship between precipitation and respiratory health. Precipitation may trigger asthma exacerbations, but little is known about how precipitation affects lung function and airway inflammation in early adolescents. Objectives: To determine if short-term precipitation exposure is associated with lung function and airway inflammation in early adolescents and if ever having a diagnosis of asthma modifies associations of precipitation with lung function and airway inflammation. Methods: In a prospective prebirth cohort, Project Viva, that included 1,019 early adolescents born in the northeastern United States, we evaluated associations of 1-, 2-, 3-, and 7-day moving averages of precipitation in the preceding week and forced expiratory volume in 1 second, forced vital capacity, and fractional exhaled nitric oxide (Fe_NO) using linear regression. We used log-transformed Fe_NO with effect estimates presented as percentage change. We adjusted for maternal education and household income at enrollment; any smoking in the home in early adolescence; child sex, race/ethnicity, and ever asthma diagnosis; and age, height, weight, date, and season (as sine and cosine functions of visit date) at the early adolescent visit and moving averages for mean daily temperature (same time window as exposure). Results: In fully adjusted linear models, 3- and 7-day moving averages for precipitation were positively associated with Fe_NO but not lung function. Every 2-mm increase in the 7-day moving average for precipitation was associated with a 4.0% (95% confidence interval, 1.1, 6.9) higher Fe_NO. There was evidence of effect modification by asthma status: Precipitation was associated with lower forced vital capacity and higher Fe_NO among adolescents with asthma. We also found that outdoor aeroallergen sensitization (immunoglobulin E against common ragweed, oak, ryegrass, or silver birch) modified associations of precipitation with Fe_NO, with higher Fe_NO in sensitized adolescents compared with nonsensitized adolescents. The associations of precipitation with Fe_NO were not explained by relative humidity or air pollution exposure. Conclusions: We found that greater short-term precipitation may trigger airway inflammation in adolescents, particularly among those with asthma.