Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Research Article
  • Published:

Indoor exposures and acute respiratory effects in two general population samples from a rural and an urban area in Italy

Journal of Exposure Science & Environmental Epidemiology volume 14, pages S144–S152 (2004)Cite this article

Abstract

A study of indoor air exposures and acute respiratory effects in adults was conducted in the Po Delta (rural) and Pisa (urban) areas of Italy. Indoor exposures were monitored for nitrogen dioxide (NO2) and particulate matter <2.5 μm (PM2.5) for 1 week during the winter or summer in a total of 421 houses (2/3 in Pisa). Information on house characteristics, subjects’ daily activity pattern and presence of acute respiratory symptoms was collected by a standardized questionnaire. Peak expiratory flow (PEF) maneuvers were performed by adult subjects four times daily; maximum amplitude and diurnal variation were taken into account. Indices of NO2 and PM2.5 exposures were computed as the product of weekly mean pollutant concentration by the time of daily exposure. Mean levels of pollutants were significantly higher in winter than in summer, regardless of the area. The relationship between exposure indices and acute respiratory symptoms was investigated only in winter. In spite of a slightly lower indoor level in the urban than in the rural area in winter (NO2: 15 vs. 22 ppb; PM2.5: 67 vs. 76 μg/m3), prevalence rates of acute respiratory symptoms were significantly higher in the urban than in the rural area. Acute respiratory illnesses with fever were significantly associated with indices of NO2 (odds ratio (OR)=1.66; 95% CI=1.08−2.57) and PM2.5 exposures (OR=1.62; 95% CI=1.04−2.51), while bronchitic/asthmatic symptoms were associated only with PM2.5 (OR=1.39; 95% CI=1.17−1.66). PEF variability was positively related only to PM2.5 exposure index (OR=1.38; 95% CI=1.24−1.54, for maximum amplitude; OR=1.37; 95% CI=1.23−1.53, for diurnal variation). In conclusion, indoor pollution exposures were associated with the presence of acute respiratory symptoms and mild lung function impairment in a rural and an urban area of Northern-Central Italy.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  • Ackermann-Liebrich U., Viegi G., and Nolan C. European Commission — Directorate General XII — Science, Research and Development. Air Pollution Report Number 6. Eur 15892 EN. Time-activity patterns in exposure assessment. Air Pollution Epidemiology Report Series 1995: 6: 1–91.

    Google Scholar 

  • Alberts W.M. Indoor air pollution: NO, NO2, CO, CO2 . J Allergy Clin Immunol 1994: 94: 289–295.

    Article  CAS  Google Scholar 

  • Baldacci S., Carrozzi L., Viegi G., and Giuntini C. Assessment of respiratory effect of air pollution: study design on general population samples. JEPTO 1997: 16: 77–83.

    CAS  PubMed  Google Scholar 

  • Bardana E.J. Indoor pollution and its impact on respiratory health. Ann Allergy Asthma Immunol 2001: 87: 33–40.

    Article  Google Scholar 

  • Braun-Fahrlander C., Ackermann Liebrich U., Schwartz J., Gnehm H.P., Rutishauser M., and Wanner H.U. Air pollution and respiratory symptoms in preschool children. Am Rev Respir Dis 1992: 145: 42–47.

    Article  CAS  Google Scholar 

  • Carrozzi L., Giuliano G., Viegi G., Paoletti P., Di Pede F., Mammini U., Carmignani G., Saracci R., Giuntini C., and Lebowitz M.D. The Po river Delta epidemiological study of obstructive lung disease: sampling methods, environmental and population characteristics. Eur J Epidemiol 1990: 6: 191–200.

    Article  CAS  Google Scholar 

  • Coultas D.B. Health effects of passive smoking — 8: passive smoking and risk of adult asthma and COPD: an update. Thorax 1998: 53: 381–387.

    Article  CAS  Google Scholar 

  • Coward S.K., Raw G.J., Llewellyn J.W., and Ross D.I. Indoor air quality in English homes — Nitrogen Dioxide. Proceedings of Indoor Air 2002: 4: 467–472.

    Google Scholar 

  • Cyrys J., Heinrich J., Richter K., Wolke G., and Wichmann H.E. Sources and concentrations of indoor nitrogen dioxide in Hamburg (west Germany) and Erfurt (east Germany). Sci Total Environ 2000: 250: 51–62.

    Article  CAS  Google Scholar 

  • Dijkstra L., Houthuijs D., Brunekreef B., Akkerman I., and Boleij J.S.M. Respiratory health effects of the indoor environment in a population of Dutch children. Am Rev Respir Dis 1990: 142: 1172–1178.

    Article  CAS  Google Scholar 

  • Eisner M.D. Environmental tobacco smoke esposure and pulmonary function among adults in NHANES III: impact on the general population and adults with asthma. Environ Health Perspect 2002: 110: 765–770.

    Article  Google Scholar 

  • Frampton M.W., Boscia J., Roberts Jr. N.J., Azadniv M., Torres A., Cox C., Morrow P.E., Nochols J., Chalupa D., Frasier L.M., Gibb F.R., Speers D.M., Tsai Y., and Utell M.J. Nitrogen dioxide exposure: effects on airway and blood cells. Am J Physiol Lung Cell Mol Physiol 2002: 282: 155–165.

    Article  Google Scholar 

  • Garret M.H., Hooper M.A., and Hooper B.M. Nitrogen dioxide in Australian homes: levels and sources. J Air Waste Manage Assoc 1999: 49: 76–81.

    Article  Google Scholar 

  • Garret M.H., Hooper M.A., Hooper D.M., and Abramson M.J. Respiratory symptoms in children and indoor exposure to nitrogen dioxide and gas stoves. Am J Respir Crit Care Med 1998: 158: 891–895.

    Article  Google Scholar 

  • Gauvin S., Reungoat P., Cassadou S., Dechenaux J., Momas I., Just J., and Zmirou D. Contribution of indoor and outdoor environments to PM2.5 personal exposure of children — VESTA study. Sci Total Environ 2002: 297: 175–181.

    Article  CAS  Google Scholar 

  • Gee I.L., Stewart L., Waston A.F.R., Fletcher G., and Niven R. Indoor air quality in smoking and non-smoking households. Proceedings of Indoor Air 2002: 2: 512–517.

    Google Scholar 

  • He Q.C., Lioy P.J., Wilson W.E., and Chapman R.S. Effects of air pollution on children's pulmonary function in urban and sub-urban areas of Wuhan, People's Republic of China. Arch Environ Health 1993: 48: 382–391.

    Article  CAS  Google Scholar 

  • Higgins B.G., Britton J.R., Chin S., Lai K.K., Burney P.G.J., and Taffersfield A.E. Factors affecting peak expiratory flow variability and bronchial reactivity in a random population sample. Thorax 1993: 48: 899–905.

    Article  CAS  Google Scholar 

  • Jaakkola M.S. Environmental tobacco smoke and respiratory diseases. In: (Annesi-Maesano I., Gulsvick A., Viegi G.) (Eds.). Respiratory Epidemiology in Europe. Eur Respir Mon 2000: 5: 322–383.

    Google Scholar 

  • Jaakkola M.S. Environmental tobacco smoke and health in the elderly. Eur Respir J 2002: 19: 172–181.

    Article  CAS  Google Scholar 

  • Jamison J.P., and McKinley R.K. Validity of peak expiratory flow rat variability for the diagnosis of asthma. Clin Sci 1993: 85: 367–371.

    Article  CAS  Google Scholar 

  • Jammes Y., Delpierre S., Delvolgo M.J., Humbert-Tena C., and Burnet H. Long-term exposure of adults to outdoor air pollution is associated with increased airway obstruction and higher prevalence of bronchial hyperresponsiveness. Arch Environ Health 1998: 53: 372–377.

    Article  CAS  Google Scholar 

  • Jarvis D., Chinn S., Luczynska C., and Burney P. Association of respiratory symptoms and lung function in young adults with use of domestic gas appliances. Lancet 1996: 347: 426–431.

    Article  CAS  Google Scholar 

  • Jarvis D., Chinn S., Sterne J., Luczynska C., and Burney P. The association of respiratory symptoms and lung function with the use of gas for cooking. European Community Respiratory Health Survey. Eur Respir J 1998: 11: 651–658.

    CAS  PubMed  Google Scholar 

  • Jedrychowski W., Maugeri U., Gomola K., Tobiasz-Adamczyk B., and Bianchi I.I . Effects of domestic gas cooking and passive smoking on chronic respiratory symptoms and asthma in elderly women. Int J Occup Environ Health 1995: 1: 16–20.

    Article  CAS  Google Scholar 

  • Klepeis N.E., Nelson W.C., Ott W.R., Robinson J.P., Tsang A.M., Switzer P., Behar J.V., Hern S.C., and Engelmann W.H. The National Human Activity Pattern Survey (NHAPS): a resource for assessing exposure to environmental pollutants. J Expos Anal Environ Epidemiol 2001: 11: 231–252.

    Article  CAS  Google Scholar 

  • Lambert W.E., Samet J.M., Hunt W.C., Skipper B.J., Schwab M., and Spengler J.D. Nitrogen dioxide and respiratory illness in children. Part II: Assessment of exposure to nitrogen dioxide. Respir Rep Health Eff Inst 1993: 58: 33–50.

    Google Scholar 

  • Lebowitz M.D., Quackenboss J.J., Soczek M.L., Kollander M., and Colome S. The new standard environmental inventory questionnaire for estimation of indoor concentrations. JAPCA 1989: 39: 1411–1419.

    Article  CAS  Google Scholar 

  • Leuenberger P., Schwartz J., Ackermann-Liebrich U., Blaser K., Bolognini G., Bongard J.P., Brandli O., Braun P., Bron C., Brutsche M., Domenighetti G., Elsasser S., Guldimann P., Hollestein C., Hufschmid P., Karrer W., Keller R., Keller-Wossidlo H., Kunzli N., Luthi J.C., Martin B.W., Medici T., Perruchoud A.P., Radaelli A., Schindler C., Schoeni M.H., Solari G., Tschopp J.M., Villiger B., Wuthrich B., Zellweger J.P., and Zemp E. Passive smoking exposure in adults and chronic respiratory symptoms (SAPALDIA Study). Am J Respir Crit Care Med 1994: 150: 1222–1228.

    Article  CAS  Google Scholar 

  • Maroni M., Carrer P., Cavallo D., Jantunen M., Katsouyanni K., Kunzli N., Sram R., Zmirou D., and Della Torre M. Air pollution exposure of adult population in Milan (Expolis Study). Proceedings of Indoor Air 2002: 4: 455–460.

    Google Scholar 

  • Monn C., Brandli O., Schindler C., Ackermann-Liebrich U., and Leuenberger P. Personal exposure to nitrogen dioxide in Switzerland. SAPALDIA team. Swiss Study on Air Pollution and Lung Diseases in Adults. Sci Total Environ 1998: 215: 243–251.

    Article  CAS  Google Scholar 

  • Moran S.E., Strachan D.P., Johnston I.D., and Anderson H.R. Effects of exposure to gas cooking in childhood and adulthood on respiratory symptoms, allergic sensitization and lung function in young British adults. Clin Exp Allergy 1999: 29: 1009–1013.

    Article  Google Scholar 

  • National Academy of Sciences, Assembly of Life Sciences. Indoor Pollutants. National Academy Press, Washington, DC, 1981.

  • Neas L.M., Dockery D.W., Ware J.H., Spengler J.D., Ferris B.G., and Speizer F.E. Concentration of indoor particulate matter as a determinant of respiratory health in children. Am J Epidemiol 1994: 139: 1088–1099.

    Article  CAS  Google Scholar 

  • Neas L.M., Dockery D.W., Ware J.H., Spengler J.D., Speizer F.E., and Ferris Jr. B.G. Association of indoor nitrogen dioxide with respiratory symptoms and pulmonary function in children. Am J Epidemiol 1991: 134: 204–219.

    Article  CAS  Google Scholar 

  • Ng T.P., Seet C.S., Tan W.C., and Foo S.C. Nitrogen dioxide exposure from domestic gas cooking and airway response in asthmatic women. Thorax 2001: 56: 596–601.

    Article  CAS  Google Scholar 

  • Özkaynak H., Xue J., Wallace L., Pellizzari E., and Jenkins P. Personal exposure to airborne particles and metals: results from the Particle TEAM study in Riverside, California. J Expos Anal Environ Epidemiol 1996: 6: 57–78.

    Google Scholar 

  • Palmes E.D., and Gunnison A.F. Personal monitoring device for gaseous contaminants. Am Ind Hyg Assoc J 1973: 34: 78–81.

    Article  CAS  Google Scholar 

  • Patterson E., and Eatough D.J. Indoor/outdoor relationships for ambient PM2.5 and associated pollutants: epidemiological implications in Lindon, Utah. J Air Waste Manage Assoc 2000: 50: 103–110.

    Article  CAS  Google Scholar 

  • Pozzoli L., and Maugeri U. Igiene Industriale, La Fondazione F. Maugeri, Clinica del lavoro, Pavia, 1986: 7: 456–459.

  • Qian Z., Zhang J., Wei F., and Chapman R.S. Impact of cooking coal smoke and heating coal smoke on respiratory health of children in four Chinese cities. Proceedings of Indoor Air 2002: 4: 1030–1035.

    Google Scholar 

  • Quackenboss J.J., Lebowitz M.D., and Krzyzanowski M. The normal range of diurnal changes in peak expiratory flow rates. Am Rev Respir Dis 1991: 143: 323–330.

    Article  CAS  Google Scholar 

  • Samet J.M., Marbury M.C., and Spengler J.D. Health effects and sources of indoor air pollution. Part I. Am Rev Respir Dis 1987: 136: 486–1508.

    Article  Google Scholar 

  • Samet J.M., Marbury M.C., and Spengler J.D. Health effects and sources of indoor air pollution. Part II. Am Rev Respir Dis 1988: 137: 221–242.

    Article  CAS  Google Scholar 

  • Sega K. Distributions of long-term household exposure of different population groups to nitrogen dioxide. J Expos Anal Environ Epidemiol 1995: 5: 35–43.

    CAS  Google Scholar 

  • Simoni M., Biavati P., Carrozzi L., Viegi G., Paoletti P., Matteucci G., Ziliani G.L., Ioannilli E., and Sapigni T. The Po river Delta (North Italy) Indoor Epidemiological Study: home characteristics, indoor pollutants, and subjects’ daily activity pattern. Indoor Air 1998: 8: 70–79.

    Article  CAS  Google Scholar 

  • Simoni M., Carrozzi L., Baldacci S., Angino A., Scognamiglio A., Di Pede F., Sapigni T., and Viegi G. The Po river Delta (North Italy) epidemiological study: effect of pollutant exposure on acute respiratory symptoms and respiratory function in adults. Arch Environ Health 2002: 57: 130–136.

    Article  CAS  Google Scholar 

  • Smith B.J., Nitschke M., Pilotto L.S., Ruffin R.E., Pisaniello D.L., and Willson K.J. Health effects of daily indoor nitrogen dioxide exposure in people with asthma. Eur Respir J 2000: 16: 879–885.

    Article  CAS  Google Scholar 

  • Spengler J. Outdoor and indoor pollution. In: Tarcher A. (Ed.). Principles and Practice of Environmental Medicine. Plenum Medical Books, New York, 1992, 21–41.

    Chapter  Google Scholar 

  • SPSS/PC+update for 10.1, 2000. SPSS Inc., Chicago, IL.

  • Venners S.A., Wang B., Ni J., Jin Y., Yang J., Fang Z., and Xu X. Indoor air pollution and respiratory health in urban and rural China. Int J Occup Environ Health 2001: 7: 173–181.

    Article  CAS  Google Scholar 

  • Viegi G., Carrozzi L., Paoletti P., Vellutini M., Ballerin L., Biavati P., Di Pede F., Pedreschi M., Modena P., Baldacci S., Diviggiano E., Sapigni T., and Giuntini C. Effects of some indoor environmental factors on respiratory symptoms and lung function in a sample of young nonsmokers in North Italy. Aerobiologia 1991: 7: 152–159.

    Article  Google Scholar 

  • Viegi G., Carrozzi L., Paoletti P., Vellutini M., Diviggiano E., Baldacci S., Modena P., Pedreschi M., Mammini U., Di Pede C., and Giuntini C. Effects of the home environment on respiratory symptoms of a general population sample in Middle Italy. Arch Environ Health 1992: 47: 64–70.

    Article  CAS  Google Scholar 

  • Viegi G., Pedreschi M., Baldacci S., Chiaffi L., Pistelli F., Modena P., Vellutini M., Di Pede F., and Carrozzi L. Prevalence rates of respiratory symptoms and diseases in general population samples of North and Central Italy. Int J Tuberc Lung Dis 1999: 3: 1034–1042.

    CAS  PubMed  Google Scholar 

  • Viegi G., Paoletti P., Carrozzi L., Vellutini M., Ballerin L., Biavati P., Nardini G., Di Pede F., Sapigni T., Lebowitz M.D., and Giuntini C. Effects of home environment on respiratory symptoms and lung function in a general population sample in North Italy. Eur Respir J 1991c: 4: 580–586.

    CAS  PubMed  Google Scholar 

  • Viegi G., Paoletti P., Carrozzi L., Vellutini M., Diviggiano E., Di Pede F., Pistelli G., Giuntini C., and Lebowitz M.D. Prevalence rates of respiratory symptoms in Italian general population samples, exposed to different levels of air pollution. Environ Health Perspect 1991a: 94: 95–99.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Wieringa M.H., Vermeire P.A., Van Bever H.P., Nelen V.J., and Weyler J.J. Higher occurrence of asthma-related symptoms in an urban than a suburban area in adults, but not in children. Eur Respir J 2001: 17: 422–427.

    Article  CAS  Google Scholar 

  • Xu X., and Li B. Exposure–response relationship between passive smoking and adult pulmonary function. Am J Respir Crit Care Med 1995: 151: 41–46.

    Article  CAS  Google Scholar 

  • Xu X., and Wang L. Association of indoor and outdoor particulate level with chronic respiratory illness. Am Rev Respir Dis 1993: 148: 1516–1522.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This work was supported in part by the Italian Research Council (CNR) — Italian Electric Energy Authority (ENEL) Special Project “Interactions of Energy System with Human Health and Environment”, by the MURST (Ministery for University and Technological & Scientific Research). We thank the staff of ENEL-S.p.A. D.C.O. Central Laboratory Unit of Piacenza (Italy) for pollutant measurement. We are particularly grateful to the families of the Po Delta and Pisa areas, who participated in the study.

Author information

Authors and Affiliations

  1. Pulmonary Environmental Epidemiological Unit, CNR Institute of Clinical Physiology, Pisa, Italy

    Marzia Simoni, Antonio Scognamiglio, Sandra Baldacci, Anna Angino & Giovanni Viegi

  2. Cardiothoracic Department, University and Hospital of Pisa, Pisa, Italy

    Laura Carrozzi, Francesco Pistelli & Francesco Di Pede

Authors
  1. Marzia Simoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Antonio Scognamiglio
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Laura Carrozzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sandra Baldacci
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anna Angino
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Francesco Pistelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Francesco Di Pede
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Giovanni Viegi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Giovanni Viegi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Simoni, M., Scognamiglio, A., Carrozzi, L. et al. Indoor exposures and acute respiratory effects in two general population samples from a rural and an urban area in Italy. J Expo Sci Environ Epidemiol 14 (Suppl 1), S144–S152 (2004). https://doi.org/10.1038/sj.jea.7500368

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jea.7500368

Keywords

This article is cited by

Search

Advanced search

Quick links