Air pollution and respiratory status in asthmatic children: hints for a locally based preventive strategy. AIRE study

Respiratory health effects of short-term exposure to ambient air pollution have been examined in 120 'asthma-like' school-aged children in some areas of Emilia-Romagna (urban-industrial and rural area). They kept a daily diary, through 12 weeks, for respiratory symptoms, PEF measurements, drug consumption and daily activity. The average daily concentrations of air pollutants in the same period (TSP, NO2, CO, PM2.5) were higher in the industrial than the rural area. Asthma was diagnosed in 77% of cases, 85% of subjects took medical treatments for respiratory disease in the last year and 90% used medicine for respiratory diseases. Significantly lower variations in PEF, between morning and evening, were observed in the rural area, considering only the asthmatic or cough subsets of children. Symptom prevalence was higher in the urban-industrial area than the rural area; the most frequent symptoms were cough, phlegm and stuffed nose. The two area populations are homogeneous in individual features, family susceptibility, passive smoking exposure and atopy. The differences observed in the frequency of daily reported symptoms could be attributed to external situations like the different reported exposures to pollutants. Although most analyses revealed non-significant associations, panel analysis showed a significant statistical risk for the cough and phlegm group by an increase of 10 microg of TSP (RR 1.0017, 95% CI: 1.0002-1.0033) in the entire group. In the urban-industrial panel we observed a significant association between cough and phlegm together and PM2.5 (RR 1.0044, 95% CI: 1.0011-1.0077). The results of this investigation should be used in orienting local political decisions.