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. 2004 Apr;61(4):e13. doi: 10.1136/oem.2003.007088

Particulate air pollution and panel studies in children: a systematic review

D Ward, J Ayres
PMCID: PMC1740745  PMID: 15031404

Abstract

Aims: To systematically review the results of such studies in children, estimate summary measures of effect, and investigate potential sources of heterogeneity.

Methods: Studies were identified by searching electronic databases to June 2002, including those where outcomes and particulate level measurements were made at least daily for ⩾8 weeks, and analysed using an appropriate regression model. Study results were compared using forest plots, and fixed and random effects summary effect estimates obtained. Publication bias was considered using a funnel plot.

Results: Twenty two studies were identified, all except two reporting PM10 (24 hour mean) >50 µg.m-3. Reported effects of PM10 on PEF were widely spread and smaller than those for PM2.5 (fixed effects summary: -0.012 v -0.063 l.min-1 per µg.m-3 rise). A similar pattern was evident for symptoms. Random effects models produced larger estimates. Overall, in between-study comparisons, panels of children with diagnosed asthma or pre-existing respiratory symptoms appeared less affected by PM10 levels than those without, and effect estimates were larger where studies were conducted in higher ozone conditions. Larger PM10 effect estimates were obtained from studies using generalised estimating equations to model autocorrelation and where results were derived by pooling subject specific regression coefficients. A funnel plot of PM10 results for PEF was markedly asymmetrical.

Conclusions: The majority of identified studies indicate an adverse effect of particulate air pollution that is greater for PM2.5 than PM10. However, results show considerable heterogeneity and there is evidence consistent with publication bias, so limited confidence may be placed on summary estimates of effect. The possibility of interaction between particle and ozone effects merits further investigation, as does variability due to analytical differences that alter the interpretation of final estimates.

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Selected References

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  1. Atkinson R. W., Anderson H. R., Sunyer J., Ayres J., Baccini M., Vonk J. M., Boumghar A., Forastiere F., Forsberg B., Touloumi G. Acute effects of particulate air pollution on respiratory admissions: results from APHEA 2 project. Air Pollution and Health: a European Approach. Am J Respir Crit Care Med. 2001 Nov 15;164(10 Pt 1):1860–1866. doi: 10.1164/ajrccm.164.10.2010138. [DOI] [PubMed] [Google Scholar]
  2. Boezen H. M., van der Zee S. C., Postma D. S., Vonk J. M., Gerritsen J., Hoek G., Brunekreef B., Rijcken B., Schouten J. P. Effects of ambient air pollution on upper and lower respiratory symptoms and peak expiratory flow in children. Lancet. 1999 Mar 13;353(9156):874–878. doi: 10.1016/S0140-6736(98)06311-9. [DOI] [PubMed] [Google Scholar]
  3. Delfino R. J., Zeiger R. S., Seltzer J. M., Street D. H. Symptoms in pediatric asthmatics and air pollution: differences in effects by symptom severity, anti-inflammatory medication use and particulate averaging time. Environ Health Perspect. 1998 Nov;106(11):751–761. doi: 10.1289/ehp.98106751. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Dockery D. W., Pope C. A., 3rd Acute respiratory effects of particulate air pollution. Annu Rev Public Health. 1994;15:107–132. doi: 10.1146/annurev.pu.15.050194.000543. [DOI] [PubMed] [Google Scholar]
  5. Gielen M. H., van der Zee S. C., van Wijnen J. H., van Steen C. J., Brunekreef B. Acute effects of summer air pollution on respiratory health of asthmatic children. Am J Respir Crit Care Med. 1997 Jun;155(6):2105–2108. doi: 10.1164/ajrccm.155.6.9196122. [DOI] [PubMed] [Google Scholar]
  6. Gold D. R., Damokosh A. I., Pope C. A., 3rd, Dockery D. W., McDonnell W. F., Serrano P., Retama A., Castillejos M. Particulate and ozone pollutant effects on the respiratory function of children in southwest Mexico City. Epidemiology. 1999 Jan;10(1):8–16. [PubMed] [Google Scholar]
  7. Hoek G., Brunekreef B. Effects of low-level winter air pollution concentrations on respiratory health of Dutch children. Environ Res. 1994 Feb;64(2):136–150. doi: 10.1006/enrs.1994.1012. [DOI] [PubMed] [Google Scholar]
  8. Hoek G., Dockery D. W., Pope A., Neas L., Roemer W., Brunekreef B. Association between PM10 and decrements in peak expiratory flow rates in children: reanalysis of data from five panel studies. Eur Respir J. 1998 Jun;11(6):1307–1311. doi: 10.1183/09031936.98.11061307. [DOI] [PubMed] [Google Scholar]
  9. Jalaludin B. B., Chey T., O'Toole B. I., Smith W. T., Capon A. G., Leeder S. R. Acute effects of low levels of ambient ozone on peak expiratory flow rate in a cohort of Australian children. Int J Epidemiol. 2000 Jun;29(3):549–557. [PubMed] [Google Scholar]
  10. Jalaludin B., Smith M., O'Toole B., Leeder S. Acute effects of bushfires on peak expiratory flow rates in children with wheeze: a time series analysis. Aust N Z J Public Health. 2000 Apr;24(2):174–177. doi: 10.1111/j.1467-842x.2000.tb00138.x. [DOI] [PubMed] [Google Scholar]
  11. Neas L. M., Dockery D. W., Burge H., Koutrakis P., Speizer F. E. Fungus spores, air pollutants, and other determinants of peak expiratory flow rate in children. Am J Epidemiol. 1996 Apr 15;143(8):797–807. doi: 10.1093/oxfordjournals.aje.a008818. [DOI] [PubMed] [Google Scholar]
  12. Neas L. M., Dockery D. W., Koutrakis P., Speizer F. E. Fine particles and peak flow in children: acidity versus mass. Epidemiology. 1999 Sep;10(5):550–553. [PubMed] [Google Scholar]
  13. Neas L. M., Dockery D. W., Koutrakis P., Tollerud D. J., Speizer F. E. The association of ambient air pollution with twice daily peak expiratory flow rate measurements in children. Am J Epidemiol. 1995 Jan 15;141(2):111–122. doi: 10.1093/oxfordjournals.aje.a117399. [DOI] [PubMed] [Google Scholar]
  14. Ostro B., Lipsett M., Mann J., Braxton-Owens H., White M. Air pollution and exacerbation of asthma in African-American children in Los Angeles. Epidemiology. 2001 Mar;12(2):200–208. doi: 10.1097/00001648-200103000-00012. [DOI] [PubMed] [Google Scholar]
  15. Peters A., Dockery D. W., Heinrich J., Wichmann H. E. Medication use modifies the health effects of particulate sulfate air pollution in children with asthma. Environ Health Perspect. 1997 Apr;105(4):430–435. doi: 10.1289/ehp.97105430. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Peters A., Dockery D. W., Heinrich J., Wichmann H. E. Short-term effects of particulate air pollution on respiratory morbidity in asthmatic children. Eur Respir J. 1997 Apr;10(4):872–879. [PubMed] [Google Scholar]
  17. Peters A., Goldstein I. F., Beyer U., Franke K., Heinrich J., Dockery D. W., Spengler J. D., Wichmann H. E. Acute health effects of exposure to high levels of air pollution in eastern Europe. Am J Epidemiol. 1996 Sep 15;144(6):570–581. doi: 10.1093/oxfordjournals.aje.a008967. [DOI] [PubMed] [Google Scholar]
  18. Peters A., Wichmann H. E., Tuch T., Heinrich J., Heyder J. Respiratory effects are associated with the number of ultrafine particles. Am J Respir Crit Care Med. 1997 Apr;155(4):1376–1383. doi: 10.1164/ajrccm.155.4.9105082. [DOI] [PubMed] [Google Scholar]
  19. Pope C. A., 3rd, Dockery D. W. Acute health effects of PM10 pollution on symptomatic and asymptomatic children. Am Rev Respir Dis. 1992 May;145(5):1123–1128. doi: 10.1164/ajrccm/145.5.1123. [DOI] [PubMed] [Google Scholar]
  20. Pope C. A., 3rd, Dockery D. W., Spengler J. D., Raizenne M. E. Respiratory health and PM10 pollution. A daily time series analysis. Am Rev Respir Dis. 1991 Sep;144(3 Pt 1):668–674. doi: 10.1164/ajrccm/144.3_Pt_1.668. [DOI] [PubMed] [Google Scholar]
  21. Pope C. A., 3rd, Schwartz J. Time series for the analysis of pulmonary health data. Am J Respir Crit Care Med. 1996 Dec;154(6 Pt 2):S229–S233. doi: 10.1164/ajrccm/154.6_Pt_2.S229. [DOI] [PubMed] [Google Scholar]
  22. Roemer W., Clench-Aas J., Englert N., Hoek G., Katsouyanni K., Pekkanen J., Brunekreef B. Inhomogeneity in response to air pollution in European children (PEACE project). Occup Environ Med. 1999 Feb;56(2):86–92. doi: 10.1136/oem.56.2.86. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Roemer W., Hoek G., Brunekreef B., Clench-Aas J., Forsberg B., Pekkanen J., Schutz A. PM10 elemental composition and acute respiratory health effects in European children (PEACE project). Pollution Effects on Asthmatic Children in Europe. Eur Respir J. 2000 Mar;15(3):553–559. doi: 10.1034/j.1399-3003.2000.15.21.x. [DOI] [PubMed] [Google Scholar]
  24. Roemer W., Hoek G., Brunekreef B. Effect of ambient winter air pollution on respiratory health of children with chronic respiratory symptoms. Am Rev Respir Dis. 1993 Jan;147(1):118–124. doi: 10.1164/ajrccm/147.1.118. [DOI] [PubMed] [Google Scholar]
  25. Roemer W., Hoek G., Brunekreef B., Haluszka J., Kalandidi A., Pekkanen J. Daily variations in air pollution and respiratory health in a multicentre study: the PEACE project. Pollution Effects on Asthmatic Children in Europe. Eur Respir J. 1998 Dec;12(6):1354–1361. doi: 10.1183/09031936.98.12061354. [DOI] [PubMed] [Google Scholar]
  26. Romieu I., Meneses F., Ruiz S., Sienra J. J., Huerta J., White M. C., Etzel R. A. Effects of air pollution on the respiratory health of asthmatic children living in Mexico City. Am J Respir Crit Care Med. 1996 Aug;154(2 Pt 1):300–307. doi: 10.1164/ajrccm.154.2.8756798. [DOI] [PubMed] [Google Scholar]
  27. Scarlett J. F., Abbott K. J., Peacock J. L., Strachan D. P., Anderson H. R. Acute effects of summer air pollution on respiratory function in primary school children in southern England. Thorax. 1996 Nov;51(11):1109–1114. doi: 10.1136/thx.51.11.1109. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Schwartz J., Dockery D. W., Neas L. M., Wypij D., Ware J. H., Spengler J. D., Koutrakis P., Speizer F. E., Ferris B. G., Jr Acute effects of summer air pollution on respiratory symptom reporting in children. Am J Respir Crit Care Med. 1994 Nov;150(5 Pt 1):1234–1242. doi: 10.1164/ajrccm.150.5.7952546. [DOI] [PubMed] [Google Scholar]
  29. Schwartz J., Neas L. M. Fine particles are more strongly associated than coarse particles with acute respiratory health effects in schoolchildren. Epidemiology. 2000 Jan;11(1):6–10. doi: 10.1097/00001648-200001000-00004. [DOI] [PubMed] [Google Scholar]
  30. Schwartz J., Spix C., Touloumi G., Bachárová L., Barumamdzadeh T., le Tertre A., Piekarksi T., Ponce de Leon A., Pönkä A., Rossi G. Methodological issues in studies of air pollution and daily counts of deaths or hospital admissions. J Epidemiol Community Health. 1996 Apr;50 (Suppl 1):S3–11. doi: 10.1136/jech.50.suppl_1.s3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Schwartz J., Wypij D., Dockery D., Ware J., Zeger S., Spengler J., Ferris B., Jr Daily diaries of respiratory symptoms and air pollution: methodological issues and results. Environ Health Perspect. 1991 Jan;90:181–187. doi: 10.1289/ehp.90-1519478. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Segala C., Fauroux B., Just J., Pascual L., Grimfeld A., Neukirch F. Short-term effect of winter air pollution on respiratory health of asthmatic children in Paris. Eur Respir J. 1998 Mar;11(3):677–685. [PubMed] [Google Scholar]
  33. Tager I. B. Current view of epidemiologic study designs for occupational and environmental lung diseases. Environ Health Perspect. 2000 Aug;108 (Suppl 4):615–623. doi: 10.1289/ehp.00108s4615. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Vedal S., Petkau J., White R., Blair J. Acute effects of ambient inhalable particles in asthmatic and nonasthmatic children. Am J Respir Crit Care Med. 1998 Apr;157(4 Pt 1):1034–1043. doi: 10.1164/ajrccm.157.4.9609008. [DOI] [PubMed] [Google Scholar]
  35. Vichit-Vadakan N., Ostro B. D., Chestnut L. G., Mills D. M., Aekplakorn W., Wangwongwatana S., Panich N. Air pollution and respiratory symptoms: results from three panel studies in Bangkok, Thailand. Environ Health Perspect. 2001 Jun;109 (Suppl 3):381–387. doi: 10.1289/ehp.01109s3381. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Ward D. J., Roberts K. T., Jones N., Harrison R. M., Ayres J. G., Hussain S., Walters S. Effects of daily variation in outdoor particulates and ambient acid species in normal and asthmatic children. Thorax. 2002 Jun;57(6):489–502. doi: 10.1136/thorax.57.6.489. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Whittemore A. S., Korn E. L. Asthma and air pollution in the Los Angeles area. Am J Public Health. 1980 Jul;70(7):687–696. doi: 10.2105/ajph.70.7.687. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. van der Zee S., Hoek G., Boezen H. M., Schouten J. P., van Wijnen J. H., Brunekreef B. Acute effects of urban air pollution on respiratory health of children with and without chronic respiratory symptoms. Occup Environ Med. 1999 Dec;56(12):802–812. doi: 10.1136/oem.56.12.802. [DOI] [PMC free article] [PubMed] [Google Scholar]

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