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Background  Evidences that oxidative stress plays a role in the associations between outdoor air pollution and asthma are growing. We aimed to study the role of plasma fluorescent oxidation products levels (FlOPs; an oxidative stress-related biomarker), as potential mediators, in the associations between outdoor air pollution and persistent asthma.    Methods  Analyses were conducted in 204 adult asthmatics followed up in the French case-control and family study on asthma (EGEA; the Epidemiological study of the Genetic and Environmental factors of Asthma). Persistent asthma was defined as having current asthma at EGEA2 (baseline, 2003–2007) and EGEA3 (follow-up, 2011–2013). Exposures to nitrogen dioxide, nitrogen oxides, road traffic, particulate matter with a diameter ≤ 10 μm (PM 10 ) and ≤ 2.5 μm were estimated by ESCAPE models (2009–2010), and ozone (O 3 ) by IFEN models (2004). We used a mediation analysis to assess the mediated effect by FlOPs levels and the interaction between FlOPs levels and air pollution.    Results  FlOPs levels increased with PM 10  and O 3  (adjusted β = 0.04 (95%CI 0.001–0.08), aβ = 0.04 (95%CI 0.009–0.07) per 10 μg/m 3 , respectively), and the risk of persistent asthma increased with FlOPs levels (aOR = 1.81 (95%CI 1.08–3.02)). The risk of persistent asthma decreased with exposures to NO 2 , NOx and PM 2.5  (aOR ranging from 0.62 to 0.94), and increased with exposures to PM 10 , O 3 , O 3-summer  and road traffic, the greater effect being observed for O 3  (aOR = 1.78, 95% CI 0.73–4.37, per 10 μg/m 3 ). Using mediation analysis, we observed a positive total effect (aOR = 2.16, 95%CI 0.70–11.9), a positive direct effect of O 3  on persistent asthma (OR = 1.68, 95%CI 0.57–7.25), and a positive indirect effect mediated by FIOPs levels (aOR = 1.28 (95%CI 1.01–2.29)) accounting for 41% of the total effect.    Conclusions  Our results add insights on the role of oxidative stress in the association between air pollution and persistent asthma.

Does the oxidative stress play a role in the associations between outdoor air pollution and persistent asthma in adults? Findings from the EGEA study