Short-Term Effects of PM10 and NO2 on Respiratory Health among Children with Asthma or Asthma-like Symptoms: A Systematic Review and Meta-Analysis

Objective Our goal was to quantify the short-term effects of particulate matter with aerodynamic diameter ≤ 10 μm (PM10) and nitrogen dioxide (NO2) on respiratory health of asthmatic children from published panel studies, and to investigate the influence of study and population characteristics as effect modifiers. Data extraction After a systematic literature review, we extracted quantitative estimates of the association of PM10 and/or NO2 with respiratory symptoms and peak expiratory flow (PEF). Combined effect estimates for an increase of 10 μg/m3 were calculated by random effects meta-analysis for all studies and for different strata defined by study characteristics. The effect of publication bias was investigated with Egger’s and Begg’s tests and “trim-and-fill” analyses. Data synthesis We identified 36 studies; 14 were part of the European Pollution Effects on Asthmatic Children in Europe (PEACE) study. Adverse associations of PM10 with asthma symptoms were statistically significant [odds ratio (OR) = 1.028; 95% confidence interval (CI), 1.006–1.051]. There were also associations, although not statistically significant, of PM10 with cough (OR = 1.012; 95% CI, 0.997–1.026) and on PEF (decrease of −0.082 L/min; 95% CI, −0.214 to 0.050). NO2 had statistically significant associations with asthma symptoms in the overall analysis considering all possible lags (OR = 1.031; 95% CI, 1.001–1.062), but not when we evaluated only the 0–1 lag. We found no publication bias, although it appeared when excluding the PEACE studies. When we applied the trim-and-fill method to the data set without the PEACE studies, the results were similar to the overall estimates from all studies. There was an indication for stronger PM10 associations for studies conducted in summer, outside of Europe, with longer lags, and in locations with higher NO2 concentrations. Conclusions We found clear evidence of effects of PM10 on the occurrence of asthma symptom episodes, and to a lesser extent on cough and PEF. The results for NO2 are more difficult to interpret because they depend on the lag times examined. There was an indication of effect modification by several study conditions.

[1]  I. Kimber.  Allergy, asthma and the environment: an introduction. , 1998, Toxicology letters.

[2]  N. Laird,et al.  Meta-analysis in clinical trials. , 1986, Controlled clinical trials.

[3]  C. Begg,et al.  Operating characteristics of a rank correlation test for publication bias. , 1994, Biometrics.

[4]  B. Brunekreef,et al.  Air pollution and respiratory health of children: the PEACE panel study in Kuopio, Finland. , 1998 .

[5]  Thomas Lumley,et al.  Ambient air pollution and asthma exacerbations in children: an eight-city analysis. , 2006, American journal of epidemiology.

[6]  R. Tweedie,et al.  A Nonparametric “Trim and Fill” Method of Accounting for Publication Bias in Meta-Analysis , 2000 .

[7]  B. Brunekreef,et al.  Acute effects of summer air pollution on respiratory health of asthmatic children. , 1997, American journal of respiratory and critical care medicine.

[8]  Michael Lipsett,et al.  Air Pollution and Exacerbation of Asthma in African-American Children in Los Angeles , 2001, Epidemiology.

[9]  J. Just,et al.  Short-term health effects of particulate and photochemical air pollution in asthmatic children , 2002, European Respiratory Journal.

[10]  L Sheppard,et al.  Effects of ambient air pollution on symptoms of asthma in Seattle-area children enrolled in the CAMP study. , 2000, Environmental health perspectives.

[11]  B. Brunekreef,et al.  Air pollution and respiratory health of children: the PEACE panel study in Pisa, Italy. , 1998 .

[12]  D. Dockery,et al.  Acute health effects of PM10 pollution on symptomatic and asymptomatic children. , 1992, The American review of respiratory disease.

[13]  Who Europe.  Air Quality Guidelines Global Update 2005: Particulate Matter, ozone, nitrogen dioxide and sulfur dioxide , 2006 .

[14]  B. Brunekreef,et al.  Effect of short-term changes in urban air pollution on the respiratory health of children with chronic respiratory symptoms: the PEACE project: introduction. , 1998 .

[15]  B. Brunekreef,et al.  Acute effects of urban air pollution on respiratory health of children with and without chronic respiratory symptoms. , 1999, Occupational and environmental medicine.

[16]  D. Dockery,et al.  The effect of air pollution on inner-city children with asthma , 2002, European Respiratory Journal.

[17]  S. Leeder,et al.  Acute effects of low levels of ambient ozone on peak expiratory flow rate in a cohort of Australian children. , 2000, International journal of epidemiology.

[18]  Thomas M Seed,et al.  Acute Effects , 2011 .

[19]  Pamela Ohman-Strickland,et al.  Respiratory effects of exposure to diesel traffic in persons with asthma. , 2007, The New England journal of medicine.

[20]  U. Ackermann-Liebrich,et al.  25 – Epidemiological Effects of Oxides of Nitrogen, Especially NO2 , 1999 .

[21]  Louise Marston,et al.  Meta-analysis of time series studies and panel studies of particulate matter (PM) and ozone (O3). Report of a WHO task group , 2004 .

[22]  D. Petitti,et al.  Approaches to heterogeneity in meta‐analysis , 2001, Statistics in medicine.

[23]  S. Thompson,et al.  Quantifying heterogeneity in a meta‐analysis , 2002, Statistics in medicine.

[24]  B. Brunekreef,et al.  Effect of ambient winter air pollution on respiratory health of children with chronic respiratory symptoms. , 1993, The American review of respiratory disease.

[25]  B. Brunekreef,et al.  Daily variations in air pollution and respiratory health in a multicentre study: the PEACE project. Pollution Effects on Asthmatic Children in Europe. , 1998, The European respiratory journal.

[26]  J. Caldwell,et al.  Review of the national ambient air quality standards for particulate matter: Policy assessment of scientific and technical information. OAQPS staff paper. Final report , 1996 .

[27]  P. Burge,et al.  Effect of domestic concentrations of nitrogen dioxide on airway responses to inhaled allergen in asthmatic patients , 1994, The Lancet.

[28]  J. Ayres,et al.  Particulate air pollution and panel studies in children: a systematic review , 2004, Occupational and Environmental Medicine.

[29]  J. Bousquet,et al.  Effect of nitrogen dioxide on synthesis of inflammatory cytokines expressed by human bronchial epithelial cells in vitro. , 1993, American journal of respiratory cell and molecular biology.

[30]  Christine E McLaren,et al.  Association of asthma symptoms with peak particulate air pollution and effect modification by anti-inflammatory medication use. , 2002, Environmental health perspectives.

[31]  J. Just,et al.  Short-term effect of winter air pollution on respiratory health of asthmatic children in Paris. , 1998, The European respiratory journal.

[32]  J Pekkanen,et al.  Fine particulate air pollution, resuspended road dust and respiratory health among symptomatic children. , 1999, The European respiratory journal.

[33]  J. Halonen,et al.  Urban air pollution, and asthma and COPD hospital emergency room visits , 2008, Thorax.

[34]  J. Schwartz,et al.  Acute effects of particulate air pollution on respiratory admissions: results from APHEA 2 project. Air Pollution and Health: a European Approach. , 2001, American journal of respiratory and critical care medicine.

[35]  J. Guillaume,et al.  [PubMed]. , 2020, Annales de dermatologie et de venereologie.

[36]  M. Dennekamp,et al.  Hypothesis: Ill health associated with low concentrations of nitrogen dioxide—an effect of ultrafine particles? , 2003, Thorax.

[37]  M. Svartengren,et al.  Repeated exposure to an ambient level of NO2 enhances asthmatic response to a nonsymptomatic allergen dose. , 1998, The European respiratory journal.

[38]  A. Peters,et al.  Short-term effects of particulate air pollution on respiratory morbidity in asthmatic children. , 1997, The European respiratory journal.

[39]  D. Dockery,et al.  Acute respiratory effects of particulate air pollution. , 1994, Annual review of public health.

[40]  R A Etzel,et al.  Effects of air pollution on the respiratory health of asthmatic children living in Mexico City. , 1996, American journal of respiratory and critical care medicine.

[41]  Edo D Pellizzari,et al.  Asthma symptoms in Hispanic children and daily ambient exposures to toxic and criteria air pollutants. , 2002, Environmental health perspectives.

[42]  Roemer,et al.  Pollution effects on asthmatic children in Europe, the PEACE study , 2000, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[43]  R. Etzel,et al.  Effects of intermittent ozone exposure on peak expiratory flow and respiratory symptoms among asthmatic children in Mexico City. , 1997, Archives of environmental health.

[44]  A. Peters,et al.  Air pollution and respiratory health of children: the PEACE panel study in Hettstedt and Zerbst., Eastern Germany. , 1998 .

[45]  J D Spengler,et al.  Estimating the mortality impacts of particulate matter: what can be learned from between-study variability? , 1999, Environmental health perspectives.

[46]  S. Vedal,et al.  Acute effects of ambient inhalable particles in asthmatic and nonasthmatic children. , 1998, American journal of respiratory and critical care medicine.

[47]  R. Delfino,et al.  Symptoms in pediatric asthmatics and air pollution: differences in effects by symptom severity, anti-inflammatory medication use and particulate averaging time. , 1998, Environmental health perspectives.

[48]  Martin L. Williams,et al.  Patterns of Air Pollution in Developed Countries , 1999 .

[49]  W. Aekplakorn,et al.  Acute effect of sulphur dioxide from a power plant on pulmonary function of children, Thailand. , 2003, International journal of epidemiology.

[50]  Richard L. Tweedie,et al.  A Non-parametric "Trim and Fill" Method of Assessing Publication Bias in Meta-analysis , 1998 .

[51]  S. Leeder,et al.  Acute effects of urban ambient air pollution on respiratory symptoms, asthma medication use, and doctor visits for asthma in a cohort of Australian children. , 2004, Environmental research.

[52]  J Schwartz,et al.  Confounding and Effect Modification in the Short-Term Effects of Ambient Particles on Total Mortality: Results from 29 European Cities within the APHEA2 Project , 2001, Epidemiology.

[53]  D. Strachan,et al.  Acute effects of winter air pollution on respiratory function in schoolchildren in southern England , 2003, Occupational and environmental medicine.