Effect of nitrogen dioxide exposure on susceptibility to influenza A virus infection in healthy adults

S. A.J. Goings, T. J. Kulle, Rebecca Bascom, L. R. Sauder, D. J. Green, R. Hebel, M. L. Clements

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57 Scopus citations


The effect of NO2 exposure and human susceptibility to respiratory virus infection was investigated in a placebo-controlled, randomized, double-blind trial conducted in an environmentally controlled research chamber over 3 yr. Healthy, nonsmoking, young adult volunteers who were seronegative to influenza A/Korea/82 (H3N2) virus were randomly assigned to breathe either filtered clean air (control group) or NO2 for 2h/day for 3 consecutive days. The NO2 concentrations were 2 ppm (Year 1), 3 ppm (Year 2), and 1 or 2 ppm (Year 3). Live, attenuated cold-adapted (ca) influenza A/Korea/82 reassortant virus was administered intranasally to all subjects immediately after the second exposure. Only one of the 152 volunteers had any symptoms; this person had a low grade fever. Pulmonary function measurements and nonspecific airway reactivity to metacholine were unchanged after NO2 exposure, virus infection, or both. Infection was determined by virus recovery, a fourfold or greater increase in serum or nasal wash influenza-specific antibody titers, or both. The infection rates of the groups were 12/21 (2 ppm NO2) versus 15/23 (clean air) in Year 1, 17/22 (3 ppm NO2) versus 15/21 (clean air) in Year 2, and 20/22 (2 ppm) and 20/22 (1 ppm) versus 15/21 (clean air) in Year 3. Each group exposed to 1 or 2 ppm NO2 in the last year became infected more often (91%) than did the control group (71%), but the differences were not statistically significant. The frequencies of infection in two of the four groups exposed to NO2 were higher than the 56 to 73% infection rates observed in previous studies in healthy adult volunteers with the same dose of ca influenza A viruses. Our findings suggest, but do not prove, that NO2 alone may play a role in increasing the susceptibility of adults to respiratory virus infections.

Original languageEnglish (US)
Pages (from-to)1075-1081
Number of pages7
JournalAmerican Review of Respiratory Disease
Issue number5
StatePublished - 1989

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine


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