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1 Asthma centre, Armand Trousseau Hospital, Paris, 2 SEPIA Consulting Firm, Melrand, and 3 National Institute of Health and Medical Research INSERM U408, Paris, France
CORRESPONDENCE: C. Ségala, SEPIA, 18 bis rue du Calvaire, 56310, Melrand, France. Fax: 33 297288110. E-mail: sepia@sepia-sante.com
Keywords: air pollution, asthma in children, generalised estimating equations, panel study
Received: April 19, 2001
Accepted May 2, 2002
This study was supported by Agence de l'Environnement et de la Maitrise de l'Energie (ADEME, grant n° 9693018), Ministère de l'Environnement and Institut Electricité Santé.
In a previous panel study in Paris, France, detrimental effects of moderately high levels of winter air pollution on the symptoms and lung function of asthmatic children were demonstrated. A new study was conducted, with the aim of assessing the short-term effects of photo-oxidant and particulate air pollution on childhood asthma during spring and early summer in Paris.
Eighty-two medically diagnosed asthmatic children were followed up for 3 months. Outcomes included the incidence and prevalence of asthma attacks, nocturnal cough, supplementary use of ß2-agonists, symptoms of airway irritation, and peak expiratory flow (PEF) value and its variability. The statistical methods controlled for the lack of independence between daily health outcomes, temporal trends and pollen and weather conditions.
Black smoke and nitrogen dioxide (NO2) were associated with increases in the occurrence of nocturnal cough and respiratory infections. Ozone (O3) was associated with an increase in the occurrence of asthma attacks and respiratory infections and with changes in lung function, as shown by an increase in PEF variability and a decrease in PEF. Statistically significant interactions were demonstrated between O3 and temperature and between O3 and pollen count for asthma attacks. O3 levels had a greater effect on additional bronchodilator use and on irritations of the eyes, nose and throat on days on which no steroids were used. Particulate matter was associated with eye irritation only.
This study showed that, although within international air quality standards, the prevailing levels of photo-oxidant and particulate pollution in spring and early summer had measurable short-term effects on children with mild-to-moderate asthma.
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