Assessment of respiratory effect of air pollution: study design on general population samples

The aim of this paper is to describe an epidemiological model to investigate the relationship between respiratory diseases and environmental air pollution. In the Po Delta prospective study, subjects were investigated before and after a large thermoelectric power plant began operating, in 1980 to 1982 and in 1988 to 1991, respectively. The Pisa prospective study was performed in 1986 to 1988 and in 1991 to 1993, before and after the construction of a new expressway that encircles the city from the North to the Southeast. In each survey, subjects completed the interviewer-administered standardized CNR questionnaire on respiratory symptoms/diseases and risk factors, and performed lung function tests. In the second survey of each study, skin prick tests, total serum IgE determination, methacholine challenge test and biomarkers (such as sister chromatide exchanges, micronuclei, chromosomal abnormalities, DNA and hemoglobin adducts) were also performed. Concentrations of total suspended particulate and SO2 in both surveys were higher in urban than in rural areas, as well as symptom/disease prevalences and bronchial reactivity. Subgroups of subjects from the two samples were enrolled to perform a specific study on the acute respiratory effects of indoor pollution; the daily presence of symptoms and measurements of peak expiratory flow (PEF), daily activity pattern, and assessment of the indoor air quality (particulates < 2.5 mu and NO2) were evaluated. Higher symptom prevalences and PEF variability level were observed in subjects with the highest levels of NO2 or particulates, especially asthmatics. In conclusion, these studies represent a basis for further analyses to better define the relationship between respiratory health and indoor/outdoor pollutant levels.