Effects of ambient air pollution on respiratory tract complaints and airway inflammation in primary school children

Respiratory health effects of ambient air pollution were studied in 605 school children 9 to 13 years in Eskişehir, Turkey. Each child performed a fractional exhaled nitric oxide (FENO) measurement and a lung function test (LFT). Self-reported respiratory tract complaints (having cold, complaints of throat, runny nose and shortness of breath/wheezing) in the last 7 days and on the day of testing were also recorded. As acute health outcomes were investigated, weekly average ambient concentrations of ozone (O3), nitrogen dioxide (NO2) and sulfur dioxide (SO2) were determined by passive sampling in the school playgrounds simultaneously with the health survey. Effects of air pollution on respiratory tract complaints and exhaled NO/lung function were estimated by multivariate logistic regression and multivariate linear mixed effects models, respectively. Upper respiratory tract complaints were significantly (p<0.05) associated with weekly average O3 concentrations during the health survey (adjusted odds ratios (OR) of 1.21 and 1.28 for a 10 μgm(-3) increment for having cold and a runny nose on day of testing, respectively). FENO levels were significantly (p<0.05) increased in children with various upper respiratory tract complaints (ratio in FENO varied between 1.16 and 1.40). No significant change in FENO levels was detected in association with any of the measured pollutants (p ≥ 0.05). Lung function was not associated with upper respiratory tract complaints and FENO levels. Peak Expiratory Flow (PEF) levels were negatively associated with weekly average O3 levels for children without upper respiratory tract complaints. In summary, elevated levels of air pollutants increased respiratory tract complaints in children.