Effects of daily variation in outdoor particulates and ambient acid species in normal and asthmatic children

Airborne Suspended Particulate Matter and the Prevalence of Allergic Conjunctivitis in Japan

Background This study aimed to examine the association of suspended particulate matter (SPM) with outpatient attendance for allergic conjunctivitis. Methodology The information on air pollution, encompassing total hydrocarbons, non-methane hydrocarbons, methane, carbon monoxide, nitrogen oxide, nitric oxide, oxidants, and SPM alongside data concerning daily weather conditions such as temperature, wind speed, and humidity, was gathered. Subsequently, the weekly mean values for outpatient visits, air pollution, and weather parameters were computed. Results The number of outpatient visits for allergic conjunctivitis was significantly associated with SPM levels (r = 0.70, p = 0.0037), oxidant levels (r = 0.70, p = 0.0038), wind speed (r = 0.48, p = 0.0472), and humidity (r = 0.77, p = 0.0009) from January to March, as well as SPM levels (r = 0.53, p = 0.0309) and carbon monoxide (r = 0.56, p = 0.0230) from April to June. Multivariate analysis showed that SPM (odds ratio = 1.37, p = 0.0161) and wind velocity (odds ratio = 1.52, p = 0.0038) were significant predictors of the number of outpatient visits from January to December. Conclusions SPM levels were the only independent predictor of outpatient visits for allergic conjunctivitis, suggesting that SPM contributes to the pathophysiology of this condition.

The relationship between particulate matter and lung function of children: A systematic review and meta-analysis

There have been many studies on the relationship between fine particulate matter (PM_2.5) and lung function. However, the impact of short-term or long-term PM_2.5 exposures on lung function in children is still inconsistent globally, and the reasons for the inconsistency of the research results are not clear. Therefore, we searched the PubMed, Embase and Web of Science databases up to May 2022, and a total of 653 studies about PM_2.5 exposures on children's lung function were identified. Random effects meta-analysis was used to estimate the combined effects of the 25 articles included. PM_2.5 concentrations in short-term exposure studies mainly come from individual and site monitoring. And for every 10 μg/m³ increase, forced vital capacity (FVC), forced expiratory volume in the first second (FEV₁) and peak expiratory flow (PEF) decreased by 21.39 ml (95% CI: 13.87, 28.92), 25.66 ml (95% CI: 14.85, 36.47) and 1.76 L/min (95% CI: 1.04, 2.49), respectively. The effect of PM_2.5 on lung function has a lag effect. For every 10 μg/m³ increase in the 1-day moving average PM_2.5 concentration, FEV₁, FVC and PEF decreased by 14.81 ml, 15.40 ml and 1.18 L/min, respectively. PM_2.5 concentrations in long-term exposure studies mainly obtained via ground monitoring stations. And for every 10 μg/m³ increase, FEV₁, FVC and PEF decreased by 61.00 ml (95% CI: 25.80, 96.21), 54.47 ml (95% CI: 7.29, 101.64) and 10.02 L/min (95% CI: 7.07, 12.98), respectively. The sex, body mass index (BMI), relative humidity (RH), temperature (Temp) and the average PM_2.5 exposure level modify the relationship between short-term PM_2.5 exposure and lung function. Our study provides further scientific evidence for the deleterious effects of PM_2.5 exposures on children's lung function, suggesting that exposure to PM_2.5 is detrimental to children's respiratory health. Appropriate protective measures should be taken to reduce the adverse impact of air pollution on children's health.

Airborne particulate matter (PM2.5) triggers cornea inflammation and pyroptosis via NLRP3 activation

Although studies have demonstrated that fine particulate matter (PM_2.5) induces ocular surface damage, PM2.5 exposure causes cornea toxicity is not entirely clear. The aim of this study is to investigate the role of the nod-like receptor family pyrin domain containing three (NLRP3) inflammasome-mediated pyroptosis in PM_2.5-related corneal toxicity. Human corneal epithelial cells (HCECs) were exposed to different concentrations of PM_2.5, and the cell viability, expressions of NLRP3 inflammasome mediated pyroptosis axis molecules and intracellular reactive oxygen species (ROS) formation were measured in HCECs. Animal experiments were undertaken to topically apply PM_2.5 suspension to mouse eyes for three months and the pyroptosis related molecules in the mouse corneas were measured. RESULTS: Our results showed a dose-dependent decrease of HCEC viability in the PM_2.5-treated cells. NLRP3 inflammasome-mediated pyroptosis axis (NLRP3, ASC, GSDMD, caspase-1, IL-1β, and IL-18) were activated in the PM_2.5-treated HCECs, accompanied by increased ROS formation. Further in vivo study confirmed the activation of this pathway in the mouse corneas exposed to PM_2.5. In conclusion, this study provids novel evidence that PM_2.5 induces corneal toxicity by triggering cell pyroptosis.

Ozone exposure and pulmonary effects in panel and human clinical studies: Considerations for design and interpretation

A wealth of literature exists regarding the pulmonary effects of ozone, a photochemical pollutant produced by the reaction of nitrogen oxide and volatile organic precursors in the presence of sunlight. This paper focuses on epidemiological panel studies and human clinical studies of ozone exposure, and discusses issues specific to this pollutant that may influence study design and interpretation as well as other, broader considerations relevant to ozone-health research. The issues are discussed using examples drawn from the wider literature. The recent panel and clinical literature is also reviewed. Health outcomes considered include lung function, symptoms, and pulmonary inflammation. Issues discussed include adversity, reversibility, adaptation, variability in ozone exposure metric used and health outcomes evaluated, co-pollutants in panel studies, influence of temperature in panel studies, and multiple comparisons. Improvements in and standardization of panel study approaches are recommended to facilitate comparisons between studies as well as meta-analyses. Additional clinical studies at or near the current National Ambient Air Quality Standard (NAAQS) of 70 ppb are recommended, as are clinical studies in sensitive subpopulations such as asthmatics.

IMPLICATIONS

The pulmonary health impacts of ozone exposure have been well documented using both epidemiological and chamber study designs. However, there are a number of specific methodological and related issues that should be considered when interpreting the results of these studies and planning additional research, including the standardization of exposure and health metrics to facilitate comparisons among studies.

Weekly Personal Ozone Exposure and Respiratory Health in a Panel of Greek Schoolchildren

BACKGROUND

The association of ozone exposure with respiratory outcomes has been investigated in epidemiologic studies mainly including asthmatic children. The findings reported had methodological gaps and inconsistencies.

OBJECTIVES

We aimed to investigate effects of personal ozone exposure on various respiratory outcomes in school-age children generally representative of the population during their normal activities.

METHODS

We conducted a panel study in a representative sample of school-age children in the two major cities of Greece, Athens and Thessaloniki. We followed 188, 10- to 11-y-old, elementary school students for 5 wk spread throughout the 2013–2014 academic year, during which ozone was measured using personal samplers. At the end of each study week, spirometry was performed by trained physicians, and the fractional concentration of nitric oxide in exhaled air (F_eNO) was measured. Students kept a daily time–activity–symptom diary and measured PEF (peak expiratory flow) using peak flow meters. Mixed models accounting for repeated measurements were applied.

RESULTS

An increase of 10 μg/m³ in weekly ozone concentration was associated with a decrease in FVC (forced vital capacity) and FEV₁ (forced expiratory volume in 1 s) of 0.03 L [95% confidence interval (CI): −0.05, −0.01] and 0.01 L (95% CI: −0.03, 0.003) respectively. The same increase in exposure was associated with a 11.10% (95% CI: 4.23, 18.43) increase in F_eNO and 19% (95% CI: −0.53, 42.75) increase in days with any symptom. The effect estimates were robust to PM₁₀ adjustment. No inverse association was found between ozone exposure and PEF.

CONCLUSIONS

The study provides evidence that airway inflammation and the frequency of respiratory symptoms increase, whereas lung function decreases with increased ozone exposure in schoolchildren. https://doi.org/10.1289/EHP635.

Airborne fine particulate matter causes murine bronchial hyperreactivity via MAPK pathway-mediated M3 muscarinic receptor upregulation

Regarding the human health effects, airborne fine particulate matter 2.5 (PM_2.5 ) is an important environmental risk factor. However, the underlying molecular mechanisms are largely unknown. The present study examined the hypothesis that PM_2.5 causes bronchial hyperreactivity by upregulated muscarinic receptors via the mitogen-activated protein kinase (MAPK) pathway. The isolated rat bronchi segments were cultured with different concentration of PM_2.5 for different time. The contractile response of the bronchi segments were recorded by a sensitive myograph. The mRNA and protein expression levels of M₃ muscarinic receptors were studied by quantitative real-time PCR and immunohistochemistry, respectively. The muscarinic receptors agonist, carbachol induced a remarkable contractile response on fresh and DMSO cultured bronchial segments. Compared with the fresh or DMSO culture groups, 1.0 µg/mL of PM_2.5 cultured for 24 h significantly enhanced muscarinic receptor-mediated contractile responses in bronchi with a markedly increased maximal contraction. In addition, the expression levels of mRNA and protein for M₃ muscarinic receptors in bronchi of PM_2.5 group were higher than that of fresh or DMSO culture groups. SB203580 (p38 inhibitor) and U0126 (MEK1/2 inhibitor) significantly inhibited the PM_2.5 -induced enhanced contraction and increased mRNA and protein expression of muscarinic receptors. However, JNK inhibitor SP600125 had no effect on PM_2.5 -induced muscarinic receptor upregulation and bronchial hyperreactivity. In conclusion, airborne PM_2.5 upregulates muscarinic receptors, which causes subsequently bronchial hyperreactivity shown as enhanced contractility in bronchi. This process may be mediated by p38 and MEK1/2 MAPK pathways. © 2016 Wiley Periodicals, Inc. Environ Toxicol 32: 371-381, 2017.

Ambient Air Pollution, Meteorological Factors and Outpatient Visits for Eczema in Shanghai, China: A Time-Series Analysis

Environmental irritants are important risk factors for skin diseases, but little is known about the influence of environmental factors on eczema incidence. In this time-series study, our objective was to examine the associations of environmental factors with outpatient visits for eczema. Daily outpatient visits between 2007 and 2011 (1826 days) were collected from Huashan Hospital in Shanghai, China. We used an overdispersed generalized additive model to investigate the short-term association between environmental factors and outpatient visits for eczema. Daily outpatient visits for eczema were significantly associated with air pollution and meteorological factors. For example, a 10 μg/m³ increase of 7-day (lag 06) average concentrations of PM₁₀ (particulate matter no greater than 10 microns), SO₂, NO₂ was associated with 0.81% (95% confidence intervals (CI) 0.39%, 1.22%), 2.22% (95% CI: 1.27%, 3.16%) and 2.31% (95% CI: 1.17%, 3.45%) increase in outpatient visits for eczema, respectively. A 10 °C elevation of temperature on lag 0 day were associated with 8.44% (95% CI: 4.66%, 12.22%) increase in eczema visits, whereas 10 unit decrease of 7-day average relative humidity were associated with 10.86% (95% CI: 8.83%, 12.89%) increase in eczema visits. This study provided clear evidence of ambient air pollution, high temperature and low relative humidity on increasing the incidence of eczema in Shanghai, China.

Effect of Asian dust on pulmonary function in adult asthma patients in western Japan: A panel study

BACKGROUND

Asian dust (AD) has become a major health concern. The concentration of AD is typically expressed in particulate matter less than 10 μm (PM10) and 2.5 μm (PM2.5). However, PM10 and PM2.5 consist of various substances besides AD. Light detection and ranging (LIDAR) systems can selectively measure the quantity of AD particles to distinguish non-spherical airborne particles from spherical airborne particles. The objective of this study was to investigate the relationship between pulmonary function in adult asthma patients and AD using LIDAR data.

METHODS

Subjects were 231 adult asthma patients who had their morning peak expiratory flow (PEF) measured from March to May 2012. A linear mixed model was used to estimate the association of PEF with sand dust particles detected by LIDAR.

RESULTS

Increases in the interquartile range of AD particles (0.018 km(-1)) led to changes in PEF of -0.42 L/min (95% confidence interval [CI], -0.85 to 0.01). An increase of 11.8 μg/m(3) in suspended particulate matter and 6.9 μg/m(3) in PM2.5 led to decreases of -0.17 L/min (-0.53 to 0.21) and 0.03 L/min (-0.35 to 0.42), respectively. A heavy AD day was defined as a day with a level of AD particles >0.032 km(-1), which was the average plus one standard deviation during the study period, and six heavy AD days were identified. Change in PEF after a heavy AD day was -0.97 L/min (-1.90 to -0.04).

CONCLUSIONS

Heavy exposure to AD particles was significantly associated with decreased pulmonary function in adult asthma patients.

Difference in interleukin-8 transcriptional activity induced in THP-G8 cells by particulate matter collected in winter and summer in western Japan

BACKGROUND

Airborne particulate matter (PM) may stimulate production of pro-inflammatory cytokines, and thus exposure to PM affects pulmonary diseases. However, the effects of PM on pulmonary diseases have differed among studies.

METHODS

PM was collected from February 2 to 28 (winter) and June 1 to 17 (summer) in 2013 in Yurihama, Japan, using filters to separate particles with different aerodynamic diameters (1.1 to <2.2 μm, 2.2 to <3.3 μm, 3.3 to <7.0 μm, and 7.0 to <10 μm). Interleukin (IL)-8 transcriptional activity in THP-G8 cells was examined in response to winter and summer PM with different diameters.

RESULTS

IL-8 transcriptional activity induced by winter PM was significantly higher than that with summer PM for each diameter. For winter PM, IL-8 activity increased with an increased diameter, whereas this activity did not differ between a solvent control and each summer PM diameter. This indicates that summer PM does not stimulate production of IL-8 in THP-G8 cells.

CONCLUSION

The effects of PM on production of pro-inflammatory cytokines differ with the season and PM diameter. This suggests that the compositions of PM differ on season, and the evaluation of compositions of PM is important in understanding the association of health with short-term exposure to PM.

Difference in Pro-Inflammatory Cytokine Responses Induced in THP1 Cells by Particulate Matter Collected on Days with and without ASIAN Dust Storms

The associations between particulate matter from Asian dust storms (ADS) and health disorders differ among studies, and the underlying mechanisms remain unclear. In this study, ADS and non-ADS particles were tested for their potential to induce pro-inflammatory cytokines associated with adverse respiratory effects. Particulate matter was collected in Japan during four periods in 2013 (2 × ADS periods; 2 × non-ADS). THP1 cells were exposed to this particulate matter, and the levels of various interleukins (ILs), and tumor necrosis factor (TNF)-α were measured. Levels of IL-2 increased significantly following exposure to all particulate matter samples (compared to levels in a solvent control). Increased levels of IL-10 and TNF-α were also observed following exposure to particles collected during three (one ADS and two non-ADS) and two (one ADS and one non-ADS) collection periods, respectively. Thus, the effects of particulate matter on cytokine responses differed according to collection period, and the effects of ADS particles differed for each ADS event. Additionally, the levels of pro-inflammatory cytokines induced by ADS particles were not always higher than those induced by non-ADS particles.

Airborne particulate matter (PM2.5) and the prevalence of allergic conjunctivitis in Japan

OBJECTIVE

Exposure to particulate matter less than 2.5 μm in diameter (PM2.5) is associated with asthma and respiratory symptoms, but little is known about the influence of PM2.5 on allergic conjunctivitis. The purpose of this study was to examine the association of PM2.5 with outpatient attendance for allergic conjunctivitis.

METHODS

We conducted a time-series analysis of the association between outpatient attendance for allergic conjunctivitis and PM2.5 levels from May to July (non-pollen season) and from August to October (the autumnal pollen season) in 2012. Air pollution data (including the levels of PM2.5, oxidants, nitric oxide, nitrogen dioxide, nitrogen oxide, carbon monoxide, methane, non-methane hydrocarbons, and total hydrocarbons) and data on the daily weather conditions (temperature, wind speed, and humidity) were collected at a centrally located monitoring station in Tokyo. We calculated weekly average values for the daily number of outpatient visits, as well as the air pollution and weather data, and used the weekly average values for analysis.

RESULTS

There was a significant association between the number of outpatient visits for allergic conjunctivitis and the PM2.5 level (r=0.62, p=0.0177) from May to July, while no correlation was found between the number of outpatient visits and any variable assessed from August to November. Multivariate analysis also showed that PM2.5 was a significant predictor of the number of outpatient visits from May to July (odds ratio=9.05, p=0.0463), while there were no significant predictors of the number of outpatient visits from August to October. From May to July, PM2.5 showed a negative correlation with humidity (r=-0.53, p=0.0499).

CONCLUSIONS

These findings suggest a possible role of PM2.5 in the development of allergic conjunctivitis during the non-pollen season. This association between PM2.5 and allergic conjunctivitis may have broad public health implications in relation to allergic diseases.

[Health impact of exposure to pollens: A review of epidemiological studies]

The aim of this review is to describe the health impact of exposure to pollen based on recently published epidemiological studies. The methodology chapter, describes a review of the literature and outlines important elements of these studies: measurement of exposure to pollens, study types used, study populations and the health indicators related to pollen exposure. In this review, two types of studies have been used to assess the epidemiological evidence of short-term links between pollen exposure and hay fever or asthma. Ecological time-series studies use daily indicators of asthma exacerbations (emergency room admissions or hospitalizations), consultations for rhinitis or conjunctivitis, or anti-allergic drug consumption within general population. Panel studies relate measurements of pollen grain concentrations to nasal, ocular and bronchial symptom severity in a group of subjects sensitized to a specific pollen, monitored during the pollen season. In both cases, the studies show a relationship on a day-to-day basis between health indicators and daily rates of atmospheric pollen collected by a pollen trap. These studies take into account confounding factors, such as air pollution, weather factors and sometimes exposure to outdoor molds. Unlike earlier studies, more and more studies focus on the shape of the dose-response relationship and the lag between pollen exposure and symptoms. Only rarely, individual susceptibility factors, the clinical phenomenon of priming and polysensitization are reported. Thus, ecological time-series studies and panel studies assess respectively the impact of pollen exposure in the general population and in groups of sensitized patients. Using appropriate statistical tools, these studies provide insight into the shape of the dose-response relationship, with a potential threshold below which symptoms are absent, then a linear relationship for nasal, ocular and bronchial symptoms and a plateau where the symptoms do not increase despite the continued increase in pollen.

The influence of socioeconomic markers on the association between fine particulate matter and hospital admissions for respiratory conditions among children

OBJECTIVES

We evaluated the influence of socioeconomic status (SES) on hospital admissions for respiratory conditions associated with ambient particulate matter that is 2.5 micrometers or less in aerodynamic diameter (PM2.5) in children aged 1 to 9 years in 12 California counties, from 2000 to 2005.

METHODS

We linked daily hospital admissions for respiratory conditions (acute respiratory infections, pneumonia, and asthma) to meteorological, air pollution, and census data.

RESULTS

In San Diego, San Bernardino, Riverside, and Los Angeles counties, the admission rates for children associated with PM2.5 ranged from 1.03 to 1.07 for combined respiratory conditions and 1.03 to 1.08 for asthma in regions with lower SES. We observed 2 distinct patterns of the influence of the composite SES Townsend index. In lower-SES South Coast areas, PM2.5-associated hospital admission rates for all respiratory outcomes were predominantly positive whereas results in the Central Valley were variable, often tending toward the null.

CONCLUSIONS

These distinct patterns could be attributed to the heterogeneity of regional confounders as well as the seasonal variation of emission sources of PM2.5. Composite SES is one potential factor for increasing susceptibility to air pollution.

Panel studies of air pollution on children's lung function and respiratory symptoms: a literature review

OBJECTIVE

This article reviews panel studies of air pollution on children's respiratory health and proposes future research directions.

METHODS

The PubMed electronic database was used to search published original epidemiological studies in peer-reviewed journals from 2000 to November 2011. Children's age was limited to ≤18 years old. A total of 33 relevant articles were obtained, with 20 articles relating to lung function, 21 articles relating to respiratory symptoms, and 8 articles examining both.

RESULTS

Most studies suggested the adverse effects of air pollution on children's lung function and respiratory symptoms. Particles and NO(2) showed more significant results, whereas effects of SO(2) were not consistent. A few studies indicated that O(3) interacted with temperature and sometimes seemed to be a protective factor for children's respiratory health. Negative associations between air pollutants and pulmonary health were more serious in asthmatic children than in healthy subjects. However, many outcomes depended on the number of lag days. Peak expiratory flow (PEF) was the most usual measurement for children's lung function, followed by forced expiratory volume in 1 second (FEV(1)).

CONCLUSIONS

There are significant adverse effects of air pollution on children's pulmonary health, especially for asthmatics. Future studies need to examine the lag effects of air pollution on children's lung function and respiratory symptoms. Ambient temperature is predicted to change worldwide due to climate change, which will threaten population health. Further research is needed to examine the effects of ambient temperature and the interactive effects between air pollution and ambient temperature on children's lung function and respiratory symptoms.

Acute respiratory health effects of air pollution on children with asthma in US inner cities

BACKGROUND

Children with asthma in inner-city communities may be particularly vulnerable to adverse effects of air pollution because of their airways disease and exposure to relatively high levels of motor vehicle emissions.

OBJECTIVE

To investigate the association between fluctuations in outdoor air pollution and asthma morbidity among inner-city children with asthma.

METHODS

We analyzed data from 861 children with persistent asthma in 7 US urban communities who performed 2-week periods of twice-daily pulmonary function testing every 6 months for 2 years. Asthma symptom data were collected every 2 months. Daily pollution measurements were obtained from the Aerometric Information Retrieval System. The relationship of lung function and symptoms to fluctuations in pollutant concentrations was examined by using mixed models.

RESULTS

Almost all pollutant concentrations measured were below the National Ambient Air Quality Standards. In single-pollutant models, higher 5-day average concentrations of NO2, sulfur dioxide, and particles smaller than 2.5 microm were associated with significantly lower pulmonary function. Higher pollutant levels were independently associated with reduced lung function in a 3-pollutant model. Higher concentrations of NO2 and particles smaller than 2.5 microm were associated with asthma-related missed school days, and higher NO2 concentrations were associated with asthma symptoms.

CONCLUSION

Among inner-city children with asthma, short-term increases in air pollutant concentrations below the National Ambient Air Quality Standards were associated with adverse respiratory health effects. The associations with NO2 suggest that motor vehicle emissions may be causing excess morbidity in this population.

Low-level ozone exposure and respiratory symptoms in infants

OBJECTIVE

Recent studies indicate that the U.S. Environmental Protection Agency (EPA) ozone standards may not protect sensitive individuals. In this study we examined respiratory effects of ozone in infants who may be vulnerable, particularly if they are children of asthmatic mothers.

DESIGN

Women delivering babies at one of five hospitals in southwestern Virginia between 1994 and 1996 were invited to participate in a cohort study; 780 women enrolled. Ambient air quality data (ozone and particulate matter) were collected at a central monitoring site.

PARTICIPANTS

This analysis is of 691 infants followed for approximately 83 days between 10 June and 31 August 1995 and/or 1996 ; they contributed a total of 52,421 infant-days of follow-up. Mothers were interviewed at enrollment and approximately biweekly to report infants' daily symptoms. Repeated measures logistic regression models were run separately for wheeze, difficulty breathing, and cough. Ozone metrics included 24-hr average, peak 1-hr, and maximum 8-hr average. Analyses were repeated for the 61 infants whose mothers had asthma.

RESULTS

For every interquartile-range increase in same-day 24-hr average ozone, likelihood of wheeze increased 37% [95% confidence interval (CI), 2-84%]. Among infants of asthmatic mothers, same-day 24-hr average ozone increased likelihood of wheeze 59% (95% CI, 1-154%) and of difficulty breathing 83% (95% CI, 42-136%). Maximum 8-hr ozone and peak 1-hr ozone were associated with difficulty breathing, but not wheeze, in infants of asthmatic mothers. Ozone was not associated with cough.

CONCLUSIONS

At levels of ozone exposure near or below current U.S. EPA standards, infants are at increased risk of respiratory symptoms, particularly infants whose mothers have physician-diagnosed asthma.

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

BACKGROUND

Panel studies have been used to investigate the short term effects of outdoor particulate air pollution across a wide range of environmental settings.

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 > or =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 microg x 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 x min(-1) per microg x 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.