Respiratory Effects of the Hebei Spirit Oil Spill on Children in Taean, Korea

Abstract

The oil spill from the Heibei Spirit in December 2007 contaminated the Yellow Coast of South Korea. We evaluated the respiratory effects of that spill on children who lived along the Yellow Coast.
Of 662 children living in the area exposed to the oil spill, 436 (65.9%) were enrolled as subjects. All subjects completed a modified International Study of Asthma and Allergies in Childhood questionnaire. A health examination, including a skin prick test, pulmonary function test, and methacholine bronchial provocation test (MBPT), was administered. The children were assigned to two groups: those who lived close to the oil spill area and those who lived far from the oil spill area.
The children who lived close to the oil spill area showed a significantly lower forced expiratory volume in one second (FEV1), an increased prevalence of 'asthma ever' (based on a questionnaire), and 'airway hyperresponsiveness' (based on the MBPT) than those who lived far from the oil spill area (FEV1; P=0.011, prevalence of 'asthma ever' based on a questionnaire; P=0.005, prevalence of 'airway hyperresponsiveness' based on the MBPT; P=0.001). The onset of wheezing after the oil spill was significantly higher in children who lived close to the oil spill area than in those who lived far from the oil spill area among the 'wheeze ever' group (P=0.002). In a multiple logistic regression analysis, male sex, family history of asthma, and residence near the oil spill area were significant risk factors for asthma (sex [male/female]: odds ratio [OR], 2.54; 95% confidence interval [CI], 1.31-4.91; family history of asthma [No/Yes]: OR, 3.77; 95% CI, 1.83-7.75; exposure group [low/high]; OR, 2.43; 95% CI, 1.27-4.65).
This study suggests that exposure to an oil spill is a risk factor for asthma in children.

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INTRODUCTION
Oil spills pose a serious threat to marine life. Major oil spill ac-
cidents have been reported in the United Arab Emirates, Kuwait,
Malaysia, India, Norway, Libya, the United States, England, Ja-
pan, France, Spain, and Pakistan.
1
Only a few studies have fo-
cused on the eect of oil spills on human health, although the
effect of oil spills on ecological systems has been extensively
studied. Most studies regarding the human health eect of oil
spills have focused on the acute toxic eects and psychological
eects of oil spills on humans.
1
Little is known about the eect
Respiratory Effects of the Hebei Spirit Oil Spill on Children in
Taean, Korea
Suk-Chul Jung,
1
Kyung-Mook Kim,
2
Kun-Song Lee,
3
Sangchul Roh,
4
Woo-Chul Jeong,
5
Sahng-June Kwak,
6
Ik-Jin Lee,
7
Young-Hyun Choi,
8
Su Ryeon Noh,
8
Jong-Il Hur,
9
Young-Koo Jee
10
*
1
Department of Occupational and Environmental Medicine, Pyeongtaek International Hospital, Pyeongtaek, Korea
2
Department of Internal Medicine, Kyeonggi-do Medical Center Suwon Hospital, Suwon, Korea
3
Department of Pediatrics, College of Medicine, Dankook University, Cheonan, Korea
4
Department of Occupational and Environmental Medicine, College of Medicine, Dankook University, Cheonan, Korea
5
Chungnam Worker’s Health Center, Cheonan, Korea
6
Department of Biochemistry, College of Medicine, Dankook University, Cheonan, Korea
7
Department of Environmental Health Science, Soonchunhyang University, Asan, Korea
8
Taean Institute of Environmental Health Center, Taean, Korea
9
Department of General Surgery, Cheonan Medical Center, Cheonan, Korea
10
Department of Internal Medicine, College of Medicine, Dankook University, Cheonan, Korea
of oil spills on the human respiratory system. A few epidemio-
logical studies have shown an increased prevalence of respira-
tory symptoms in residents or clean-up workers immediately
Original Article
Allergy Asthma Immunol Res. 2013 November;5(6):365-370.
http://dx.doi.org/10.4168/aair.2013.5.6.365
pISSN 2092-7355 • eISSN 2092-7363
Purpose: The oil spill from the Heibei Spirit in December 2007 contaminated the Yellow Coast of South Korea. We evaluated the respiratory ef-
fects of that spill on children who lived along the Yellow Coast. Methods: Of 662 children living in the area exposed to the oil spill, 436 (65.9%)
were enrolled as subjects. All subjects completed a modied International Study of Asthma and Allergies in Childhood questionnaire. A health ex-
amination, including a skin prick test, pulmonary function test, and methacholine bronchial provocation test (MBPT), was administered. The children
were assigned to two groups: those who lived close to the oil spill area and those who lived far from the oil spill area. Results: The children who
lived close to the oil spill area showed a signicantly lower forced expiratory volume in one second (FEV1), an increased prevalence of ‘asthma ever’
(based on a questionnaire), and ‘airway hyperresponsiveness’ (based on the MBPT) than those who lived far from the oil spill area (FEV1; P
=
0.011,
prevalence of ‘asthma ever’ based on a questionnaire; P
=
0.005, prevalence of ‘airway hyperresponsiveness’ based on the MBPT; P
=
0.001). The on-
set of wheezing after the oil spill was signicantly higher in children who lived close to the oil spill area than in those who lived far from the oil spill
area among the ‘wheeze ever’ group (P
=
0.002). In a multiple logistic regression analysis, male sex, family history of asthma, and residence near the
oil spill area were signicant risk factors for asthma (sex [male/female]: odds ratio [OR], 2.54; 95% condence interval [CI], 1.31-4.91; family history
of asthma [No/Yes]: OR, 3.77; 95% CI, 1.83-7.75; exposure group [low/high]; OR, 2.43; 95% CI, 1.27-4.65). Conclusions: This study suggests that
exposure to an oil spill is a risk factor for asthma in children.
Key Words: Asthma; airway hyperresponsiveness; prevalence; industrial oils
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits
unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Correspondence to: Young-Koo Jee, MD, PhD, Department of Internal
Medicine, Dankook University College of Medicine, 119 Dandae-ro,
Dongnam-gu, Cheonan 110-744, Korea.
Tel: +82-41-550-3923; Fax: +82-41-556-3256; E-mail: ykjee@dankook.ac.kr
Received: November 23, 2012; Revised: January 24, 2013
Accepted: February 13, 2013
•There are no financial or other issues that might lead to conflict of interest.

Jung et al.
Allergy Asthma Immunol Res. 2013 November;5(6):365-370. http://dx.doi.org/10.4168/aair.2013.5.6.365
Volume 5, Number 6, November 2013
366
http://e-aair.org
after exposure to an oil spill, which may be prolonged after the
spill.
2-8
e eect of oil spills on lung function has been incon-
sistent in several clinical studies.
2,8-11
ere has been only one
study in children that showed no deleterious eect of exposure
to an oil spill on lung function.
9
On December 7, 2007, a crane barge being towed by a tug col-
lided with an anchored crude oil carrier, the Hebei Spirit.
12
e
Hebei Spirit was carrying 260,000 tons of crude oil, which in-
cluded Iranian heavy oil, Upper Zakum oil, and Kuwait Export
oil. About 10,000 tons of crude oil was spilt into the sea and con-
taminated the coastline (about 167 kilometers long). e oil was
composed of volatile organic compounds (VOCs) such as ben-
zene, toluene, ethylbenzene, or xylene, polyaromatic hydrocar-
bons (PAHs), and heavy metals. VOCs, which typically contain
1-18 carbon atoms, are associated with indoor air pollution and
adverse health eects such as respiratory tract irritation, bron-
chitis, and irritation to the skin.
13
Recent epidemiological studies have shown that VOCs are as-
sociated with impaired lung function and an increased preva-
lence of asthma in children as well as in adults.
13-15
PAHs, a group
of small organic compounds containing three to ve benzene
rings, can induce oxidative stress in the respiratory tract and ag-
gravate asthma symptoms.
16-18
e aim of this study was to eval-
uate the respiratory eect of oil spill exposure on children.
MATERIALS AND METHODS
Study population
e present study was performed to evaluate the respiratory
eects of oil spill exposure on children living in the area exposed
to the spill. e study protocol was approved by the Institution-
al Review Board of Dankook University Hospital. Of 662 children
(aged 6 to 12 years) living in the area exposed to the oil spill, 436
(65.9%) who completed a questionnaire and agreed to partici-
pate in the study were enrolled. A health examination, includ-
ing a skin prick test, pulmonary function test, and methacholine
bronchial provocation test (MBPT), was performed. e skin
prick test was performed in 418 children (95.9%); 18 children
refused the test. e pulmonary function test was performed
for all 436 children, and the MBPT was performed for 103 chil-
dren (23.6%) who were suspected of having bronchial asthma
based on their responses to the questionnaire. e health ex-
amination was performed during 10 days in June 2009. ere
was no control group without oil spill exposure, epidemiologic
data before the accident were absent, and the concentration of
air pollution at the time of the accident was not measured. Con-
sequently, we did not directly evaluate the eects of oil spill ex-
posure. erefore, we divided the children into groups accord-
ing to those who lived close to or far from the oil spill area (i.e.,
whether they lived within 2 km of the contaminated coastline
[Figure]).
Questionnaire
e Modied International Study of Asthma and Allergies in
Childhood questionnaire (Korean version) was used to evaluate
characteristics related to asthma.
19
e prevalence of asthma
(asthma ever) was determined by asking the subject whether
he/she had ever been diagnosed with asthma by a doctor. e
prevalence of wheezing (wheeze ever) was determined by life-
time and current (during the last 12 months) wheezing episodes.
A question about whether the asthma symptoms began before
or after oil spill exposure was added to the questionnaire.
e questionnaires, which were completed by the parents of
the study subjects before the health examination, were collected
on the day of the examination.
Skin prick test
e skin prick test was performed in 418 children (95.9%). Sub-
jects were tested for common inhalant allergens (house dust
mites, cockroach, mixed grass pollen, mixed tree pollen, weed
pollen, cat hair, and mold mixture; Allergopharma, Reinbek,
Germany). e skin prick test was performed by three trained
personnel at our center. The skin test result was regarded as
positive when the wheal size of the allergen was more than 3
mm and larger than that of histamine.
Pulmonary function test
The pulmonary function test was performed according to
American oracic Society guidelines.
20
e forced expiratory
volume in one second (FEV1) and forced vital capacity (FVC)
were measured by three trained personnel at our center using a
portable micro-spirometer (Microspiro HI-298; Chest Corp.,
Tokyo, Japan).
Heibei Spirit
Collision
8 km
High
exposure
area
Low
exposure
area
Figure. Map showing the location of the Heibei Spirit oil spill and the areas of
high and low exposure according to the distance from the spill.

Respiratory Effects of the Hebei Spirit Oil Spill
Allergy Asthma Immunol Res. 2013 November;5(6):365-370. http://dx.doi.org/10.4168/aair.2013.5.6.365
AAIR
367
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MBPT
The MBPT was administered using a modified version of
Chai’s method
21
to 104 children from the asthma ever or wheeze
ever group. Briey, the FEV1 and FVC were measured using a
spirometer (Microspiro HI-298; Chest Corp.), taking the largest
values of triplicate FEV1 and FVC measurements. e subjects
inhaled ve breaths of increasing methacholine concentration
until the FEV1 fell to less than 80% of its baseline value or the
highest concentration of methacholine was reached. Triplicate
FEV1 measurements were made starting at 90 s after each inha-
lation, and the largest value was used for analysis. If the concen-
tration of methacholine that caused a 20% fall in FEV1 was less
than 16 mg/mL, the subject was considered to have ‘airway hy-
perresponsiveness.’
Statistical analysis
A statistical analysis was performed using SPSS version 17.0
(SPSS Inc., Chicago, IL, USA). An independent t-test was used
to compare continuous variables such as age, height, or weight,
and pulmonary function test results between the study groups.
A chi-squared test was used to compare categorical variables
such as sex, family history of asthma, smoking, asthma ever,
wheeze ever, symptoms related to asthma within 12 months,
some of the skin prick test results, and the prevalence of asthma
between the study groups. Fisher’s exact test was used for non-
parametric categorical variables such as the onset of wheezing
and some of the skin prick test results. A multiple logistic regres-
sion analysis was used to evaluate risk factors for the prevalence
of asthma in the study population. Statistical signicance was
dened as a P value less than 0.05.
RESULTS
Questionnaire
e mean age of the study subjects was 9.6 years, and the ra-
tio of males to females was 0.8 (Table 1). Children who lived
close to or far from the oil spill area showed no signicant dif-
ferences in terms of age, sex, height, weight, and family history
of asthma. Children who lived close to the oil spill area were
weighted and exposed to passive smoke compared with those
who lived far from the oil spill area. e percentage of children
who were current smokers was similar between the two groups
(Table 1). e prevalence of ‘asthma ever’ was 14.0%; the preva-
lence of ‘wheeze ever’ was 19.0%. In a univariate analysis for
characteristics related to asthma, the number of children with
previously diagnosed asthma and reported wheezing after oil
spill exposure was significantly higher in children who lived
close to the oil spill area than in those who lived far from the oil
spill area (P
=
0.005 and 0.002, respectively). e number of chil-
dren with wheezing-limited speech, sleep disturbances caused
by wheezing, or absence from school due to wheezing within
the previous 12 months was not signicantly dierent between
Table 1. Participant characteristics
Variables
Children living close to the
oil spill area (N
=
159)
Children living far from the
oil spill area (N
=
277)
Total (N
=
436) P value*
Age (year) 9.8
±
1.6 9.5
±
1.7 9.6
±
1.7 0.063
†
Sex Male 70 (44.0) 124 (44.8) 194 (44.5) 0.881
Female 89 (56.0) 153 (55.2) 242 (55.5)
Height (cm) 137.8
±
10.8 136.1
±
11.8 136.7
±
11.5 0.140
†
Weight (kg) 35.8
±
11.0 33.5
±
10.5 34.3
±
10.8 0.030
†
Family history of asthma (yes/no) 26 (16.4) 35 (12.6%) 61 (14.0) 0.282
Smoking Current 8 (5.1) 9 (3.3) 17 (3.9) 0.349
Passive 85 (56.7) 101 (38.5) 186 (45.1) 0.000
Asthma ever (yes/no) 32 (20.1) 29 (10.5) 61 (14.0) 0.005
Wheeze ever (yes/no) 38 (23.9) 45 (16.2) 83 (19.0) 0.050
Onset of wheezing
Before the oil spill 23 (69.7) 35 (97.2) 58 (84.1) 0.002
‡
After the oil spill 10 (30.3) 1 (2.8) 11 (15.9)
Episode within the previous 12 months (yes/no)
Wheezing at rest 18 (11.3) 16 (5.8) 34 (7.8) 0.038
Wheezing after exercise 22 (13.8) 15 (5.4) 37 (8.5) 0.002
Wheezing-limited speech 11 (6.9) 16 (5.8) 27 (6.2) 0.634
Sleep disturbance caused by wheezing 13 (8.2) 11 (4.0) 24 (5.5) 0.064
Absence from school 14 (8.8) 12 (4.3) 26 (6.0) 0.058
Treatment due to asthma 14 (8.8) 11 (4.0) 25 (5.7) 0.037
*Chi-square test;
†
Independent t-test;
‡
Fisher’s exact test.

Jung et al.
Allergy Asthma Immunol Res. 2013 November;5(6):365-370. http://dx.doi.org/10.4168/aair.2013.5.6.365
Volume 5, Number 6, November 2013
368
http://e-aair.org
the groups. However, the number of children with wheezing at
rest, wheezing after exercise, or treatment due to asthma within
the previous 12 months was signicantly higher in children who
lived close to the oil spill area than in children who lived far from
the oil spill area (P
=
0.038, 0.002, and 0.037, respectively).
Skin prick test
House dust mites, which were positive in 101 children (24.2%),
were the most common aeroallergen in the study subjects (Ta-
ble 2). In decreasing order, molds were positive in 19 subjects
(4.5%), tree pollen was positive in 11 subjects (2.6%), weed pol-
len was positive in 8 subjects (1.9%), cat hair was positive in 8
subjects (1.9%), cockroach was positive in 8 subjects (1.9%), and
grass pollen was positive in 5 subjects (1.2%). However, the rate
of skin test positivity showed no signicant dierence between
the two groups.
Pulmonary function test
e FEV1 was signicantly lower in children who lived close
to the oil spill area than in those who lived far from the oil spill
area, although the FVC and FEV1/FVC ratio were not signicant-
ly dierent between the two groups (P
=
0.011; Table 3).
Prevalence of asthma and risk factors for asthma
e prevalence of ‘wheeze ever’ and ‘wheeze current’ based
on the questionnaire was signicantly higher in children who
lived close to the oil spill area than in those who lived far from
the oil spill area (P
=
0.050 and 0.002, respectively; Table 1). e
prevalence of ‘increased airway hyperresponsiveness’ based on
the MBPT was also signicantly higher in children who lived
close to the oil spill area than in those who lived far from the oil
spill area (P
=
0.001; Table 3). In the multiple logistic regression
analysis, male sex, family history of asthma, and residence close
to the oil spill area were signicant risk factors for asthma (male
sex: odds ratio [OR], 2.54; 95% condence interval [CI]: 1.31-4.91;
family history of asthma: OR, 3.77; 95% CI: 1.83-7.75; residence
close to the oil spill area: OR, 2.43; 95% CI: 1.27-4.65; Table 4).
DISCUSSION
e present study shows that children who lived close to the
oil spill area had more asthmatic symptoms, increased impaired
lung function, and an increased prevalence of asthma than
those who lived far from the oil spill area. e risk factors for
asthma in our study subjects were male sex, family history of
asthma, and residence close to the oil spill area.
Oil spill exposure has hazardous eects on marine life; how-
ever, few studies have reported the eects of oil spill exposure
on human health. Particularly, little is known regarding the ef-
fect of oil spill exposure on the human respiratory system. When
an oil spill occurs, local inhabitants or volunteers who partici-
pate in clean-up activities constitute a population whose health
may be aected by the oil spill because they are highly exposed
to the spill immediately after the accident. A few epidemiologic
studies have shown acute or prolonged respiratory symptoms
in residents as well as in clean-up workers exposed to an oil
Table 2. Skin prick test results in the study participants
Children living
close to the oil
spill area
(N
=
151)
Children living
far from the oil
spill area
(N
=
267)
Total
(N
=
418)
P value*
House dust mites 36 (23.8) 65 (24.3) 101 (24.2) 0.908
Cockroach 3 (2.0) 5 (1.9) 8 (1.9) 1.000
†
Grass pollen 1 (0.7) 4 (1.5) 5 (1.2) 0.658
†
Tree pollen 6 (4.0) 5 (1.9) 11 (2.6) 0.197
Weed pollen 3 (2.0) 5 (1.9) 8 (1.9) 1.000
†
Cat hair 3 (2.0) 5 (1.9) 8 (1.9) 1.000
†
Molds 8 (5.3) 11 (4.1) 19 (4.5) 0.579
*Chi-squared test;
†
Fisher’s exact test.
Table 4. Risk factors for asthma in the study participants
Variables
Adjusted OR (95%
condence interval)
P value*
Sex (male/female) 2.54 (1.31-4.91) 0.006
Obesity (obese/overweight/normal weight)
Overweight 1.88 (0.79-4.47) 0.15
Obese 1.86 (0.89-3.87) 0.10
Familial history of asthma (yes/no) 3.77 (1.83-7.75) 0.000
Current smoking (yes/no) 0.39 (0.05-3.35) 0.393
Passive smoking (yes/no) 1.29 (0.67-2.50) 0.451
Residence (close to/far from the oil spill area) 2.43 (1.27-4.65) 0.007
*Multiple logistic regression analysis.
OR, odds ratio.
Table 3. Pulmonary function test results and the prevalence of asthma in the
study participants
Children living
close to the oil
spill area
(N
=
159)
Children living
far from the oil
spill area
(N
=
277)
Total
(N
=
436)
P value*
FVC (L) 2.01
±
0.47 1.97
±
0.49 1.98
±
0.48 0.396
FVC (%) 85.6
±
10.5 86.8
±
11.6 86.4
±
11.2 0.275
FEV1 (L) 1.78
±
0.40 1.77
±
0.43 1.77
±
0.42 0.723
FEV1 (%) 82.6
±
10.8 85.3
±
10.4 84.3
±
10.6 0.011
FEV1/FVC (%) 89.3
±
0.07 90.2
±
0.06 89.9
±
0.06 0.153
Prevalence of bron-
chial hyperrespon-
siveness (dened
by the MBPT)
29 (18.2) 22 (7.9) 51 (11.7) 0.001
†
*Independent t-test;
†
Chi-squared test.
FVC, forced vital capacity; FEV1, forced expiratory volume in one second.

Respiratory Effects of the Hebei Spirit Oil Spill
Allergy Asthma Immunol Res. 2013 November;5(6):365-370. http://dx.doi.org/10.4168/aair.2013.5.6.365
AAIR
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http://e-aair.org
spill.
2-8,22
However, these studies were performed in adults who
lived near the oil spill area or who had participated in clean-up
activities. Only one study documented the eect of oil spills on
children, in which children who lived near the oil spill area did
not have impaired lung function immediately after the spill.
9
Our study showed increased respiratory symptoms in children
who lived close to the oil spill area after the spill. is nding is
consistent with previous study results showing increased respi-
ratory symptoms in adults exposed to an oil spill.
e eect of oil spill exposure on lung function produced in-
consistent results in several clinical studies. Earlier studies have
shown that lung function in adults or children who lived near
the oil spill area did not deteriorate immediately after the spill.
2,9
Only one study on the eect of oil spill exposure in children who
lived near the oil spill area did not show impaired lung function
immediately after the spill.
9
Conversely, our study showed that
the FEV1 (%) was signicantly reduced in children who lived
close to the oil spill area compared to those who lived far from
the oil spill area. e dierence in the results between our study
and Crum’s study
9
can be explained by the dierence in time of
the performance of the lung function test after the oil spill acci-
dent. erefore, we believe that our study better reects the long-
term eects of oil spill exposure than Crum’s study.
9
In other
studies, clean-up workers who participated in clean-up activi-
ties after oil spill exposure showed impaired lung function short-
ly after the oil spill, which was reversible 1 year after the spill.
10,11
In a recent study of the eect of oil spill exposure on 501 clean-
up workers, no signicant dierence in lung function was de-
tected between clean-up workers and controls without expo-
sure to the oil spill 2 years after the spill.
8
However, makers of
airway injury such as 8-isoprostane, which reect local oxida-
tive stress, were increased in the breath condensate of clean-up
workers, and a subgroup of nonsmokers had a higher risk of
bronchial hyperreactivity in a methacholine bronchial chal-
lenge.
8
In our study, children who lived close to the oil spill area
had increased impaired lung function than those who lived far
from the oil spill area 18 months after the spill. is inconsistent
nding may be due to physiologic dierences between children
and adults or a genetic factor, although further study is needed
to determine the causes of these discrepancies.
Our study revealed that children who lived close to the oil spill
area had more asthmatic symptoms, increased impaired lung
function, and an increased prevalence of bronchial hyperreac-
tivity than those who lived far from the oil spill area. However,
there are limitations to our study in that a control group without
oil spill exposure could not be included, and only 436 children
(65.9%) were enrolled among the 662 children living in the area
exposed to the oil spill. us, a possibility of selection bias ex-
ists. Furthermore, epidemiologic data before the accident such
as asthma prevalence at the study area were absent. We could
not directly assess whether the prevalence of asthma was in-
creased after the accident at the oil spill area.
erefore, we divided the children into those who lived close
to or far from the oil spill area (i.e., whether they lived within 2
km of the contaminated coastline). Additionally, we hypothe-
sized that children who lived far from the oil spill area (more
than 2 km) were less inuenced by the oil spill because there is
a hill 2 km from the accident area.
e prevalence of asthma in our study subjects was compared
with that in a nationwide survey performed during 2006 and
2007. e prevalence of ‘asthma ever’ and ‘wheeze ever’ in our
study subjects was 14.0 and 19.0%, respectively, which is about
twice as high as that in a nationwide survey of 30,893 children
in Korea.
23
e prevalence of asthma based on the MBPT in our
study participants was 11.7%, which was more than twice as
high as that in a survey of 622 children and teenagers between
the ages of 7 and 19 years in Korea.
24
e prevalence of asthma
in Taean is higher than that in the general population. The
causes of the dierence in prevalence are not obvious. We sup-
pose that the coastal climate, yellow dust, and air pollution in-
uenced the development of asthma in the Taean area. Howev-
er, despite the regional characteristics concerning oil spill expo-
sure in Taean, our study is remarkable in that wheeze ever was
increased in children who lived close to the oil spill area after
the spill, and the prevalence of bronchial hyperreactivity was
higher in children who lived close to the oil spill area.
e present results support those of a study that showed in-
creased markers of airway injury and a high prevalence of bron-
chial hyperreactivity in clean-up workers 2 years after oil spill
exposure.
8
e study suggests that prolonged asthmatic symp-
toms after oil spill exposure may be mediated through bronchi-
al hyperreactivity from airway inammation induced by some
irritants included in crude oil, although biologic markers relat-
ed to airway inammation were not measured in our study.
VOCs and PAHs are irritants of toxicological interest included
in crude oil. Recent epidemiological studies have shown that
VOCs are associated with impaired lung function and an in-
creased prevalence of asthma in children as well as in adults.
13-15
PAHs can induce oxidative stress in the respiratory tract and ag-
gravate asthma symptoms.
16-18
Acute irritant-induced asthma—
also called reactive airways dysfunction syndrome—is caused
by an inhalation accident in an occupational or the general en-
vironment.
25
e most well-known outbreak of this syndrome
occurred following the World Trade Center disaster, in which
firefighters were exposed to various irritants.
26
Similar to the
acute irritant-asthma observed in the World Trade Center di-
saster, our study shows that oil spill exposure can aect the de-
velopment or aggravation of acute irritant-induced asthma.
Considering the results of the present study, a long-term fol-
low-up study of the children who participated in our study will
be needed to evaluate the relationship between oil spill expo-
sure and the prevalence of asthma.
Our study results suggest that oil spill exposure is a risk factor
for asthma in children. Future longitudinal studies will be need-

Jung et al.
Allergy Asthma Immunol Res. 2013 November;5(6):365-370. http://dx.doi.org/10.4168/aair.2013.5.6.365
Volume 5, Number 6, November 2013
370
http://e-aair.org
ed to demonstrate the relationship between oil spill exposure
and asthma and should include biologic markers related to air-
way inammation to reveal the mechanism whereby oil spill
exposure induces impaired lung function and increases the
prevalence of asthma.
ACKNOWLEDGMENTS
is study was supported by a Taean Environmental Health
Center operating grant for the investigation of mid- and long
term health eects of the Hebei Spirit Oil Spill from the Ministry
of Environment, Republic of Korea.
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