According to data presented at the EULAR Annual Congress, real-time air pollution exposure may have an effect on disease activity and airway inflammation in patients with childhood-onset systemic lupus erythematous.

“This is the first study that evaluated personal pollutants exposure with portable monitors in [childhood-onset systemic lupus erythematous] cSLE patients,” Maria Fernanda Giacomin Goulart, MD, from the Department of Pediatric Rheumatology at University of Sao Pāulo, said in a press conference. “We concluded that inhaled fine particles was higher than recommended by the World Health Organization [WHO]. We observed [in] patients, the median [fine particle matter] PM.2.5 mean daily concentration was 40 and the recommended [concentration] by WHO is 25 and indoor and outdoor exposure was associated with increase of airways inflammation and disease activity.”

Goulart and colleagues performed a longitudinal panel study with 108 consecutive visits of patients with cSLE. During the course of 4 weeks, investigators obtained daily personal measures of nitrogen dioxide (NO2), PM.2.5, ambient temperature and humidity, and obtained these measures every 2.5 months during the course of 1 year. They collected the pH of exhaled breath condensate (EBC pH), fractional exhaled nitric oxide (FeNO) and disease activity parameters weekly. The effect of the pollutants on the risk of moderate/severe disease activity was evaluated with specific generalized estimation models.

“As a result, we can see FeNO in relation to inhaled fine particles were observed [to] increase in first 3 days after exposure and also NO2 7-day cumulative, suggesting that air inflammation may be related to air pollution,” she said.

Goulart also noted that in relation to the inhaled fine particles, the EBC pH decreased in the earlier days of exposure, more specifically days 7 and 11, which demonstrated exposure to inhaled fine particles was associated to the acidification and/or inflammation of the airways.

“And remarkable, the increase in relative risk of moderate and severe disease activity was observed on days 4 and 11 after exposure indicating that exposure to air pollution may aggravate disease activity,” Goulart added. – by Monica Jaramillo