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.

Is daily exposure to ozone associated with respiratory morbidity and lung function in a representative sample of schoolchildren? Results from a panel study in Greece

Abstract

Previous time series or panel studies of asthmatics have reported respiratory health effects following short-term exposure to ozone (O3). We followed 186 children aged 10 years old in Athens and Thessaloniki, Greece for 5 weeks during the academic year 2013–2014 and recorded daily their respiratory symptoms, absenteeism and peak expiratory flow (PEF). We applied mixed models controlling for various possible confounders to investigate the daily associations between O3 exposure — derived from weekly personal and fixed school site measurements calibrated using daily values of the fixed monitoring site nearest to the child’s school location — and PEF, presence of any symptom, cough and stuffy nose, as well as absenteeism. We tested the robustness of our findings to varying modeling assumptions and confounders and investigated effect modification patterns by medication use, time spent outdoors and prevalence of asthma. A 10 μg/m3 increase in O3 personal exposure was associated with increased odds of any symptom (odds ratio (OR): 1.19, 95% confidence interval (CI): 0.98, 1.44), largely attributed to the increase in the odds of stuffy nose (OR: 1.23, 95% CI: 1.00, 1.51). PEF and absenteeism were not related to O3 exposure. Our results were robust to several sensitivity analyses. Effects were modified by medication use as presence of symptoms but also decreases in PEF were mainly reported among non-users, while our effect estimates were not driven by the asthmatic subgroup of children. Our findings indicate that short-term O3 exposure may be associated with respiratory symptoms extending previously reported results for asthmatics to the general population.

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

Relevant articles

Open Access articles citing this article.

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

References

  1. World Health Organization Review of Evidence on Health Aspects of Air Pollution – REVIHAAP Project: Final Technical Report. WHO. 2013.

  2. Pope CA, III, Dockery DW . Health effects of fine particulate air pollution: lines that connect. J Air Waste Manag Assoc 2006; 56: 709–742.

    Article  CAS  Google Scholar 

  3. US Environmental Protection Agency 2010. Available at: www.epa.gov/air/criteria/.html. (accessed 15 December 2015).

  4. Tager IB, Balmes J, Lurmann F, Ngo L, Alcorn S, Künzli N . Chronic exposure to ambient ozone and lung function in young adults. Epidemiology 2005; 16: 751–759.

    Article  Google Scholar 

  5. Geyh AS, Xue J, Ozkaynak H, Spengler JD . The Harvard Southern California Chronic Ozone Exposure Study: assessing ozone exposure of grade-school-age children in two Southern California communities. Environ Health Perspect 2000; 108: 265–270.

    Article  CAS  Google Scholar 

  6. Bell ML, Zanobetti A, Dominici F . Who is more affected by ozone pollution? A systematic review and meta-analysis. Am J Epidemiol 2014; 180: 15–28.

    Article  Google Scholar 

  7. Bell ML, McDermott A, Zeger SL, Samet JM, Dominici F . Ozone and short-term mortality in 95 US urban communities, 1987–2000. JAMA 2004; 292: 2372–2378.

    Article  CAS  Google Scholar 

  8. Bell ML, Dominici F, Samet JM . A meta-analysis of time-series studies of ozone and mortality with comparison to the National Morbidity, Mortality, and Air Pollution Study. Epidemiology 2005; 16: 436–445.

    Article  Google Scholar 

  9. Levy JI, Chemerynski SM, Sarnat JA . Ozone exposure and mortality: an empiric Bayes metaregression analysis. Epidemiology 2005; 16: 458–468.

    Article  Google Scholar 

  10. Ito K, De Leon SF, Lippmann M . Associations between ozone and daily mortality: analysis and meta-analysis. Epidemiology 2005; 16: 446–457.

    Article  Google Scholar 

  11. Samoli E, Zanobetti A, Schwartz J, Atkinson R, LeTertre A, Schindler C et al. The temporal pattern of mortality responses to ambient ozone in the APHEA project. J Epidemiol Community Health 2009; 63: 960–966.

    Article  CAS  Google Scholar 

  12. Peng RD, Samoli E, Pham L, Dominici F, Touloumi G, Ramsay T et al. Acute effects of ambient ozone on mortality in Europe and North America: results from the APHENA study. Air Qual Atmos Health 2013; 6: 445–453.

    Article  CAS  Google Scholar 

  13. Moreno-Macías H, Dockery DW, Schwartz J, Gold DR, Laird NM, Sienra-Monge JJ et al. Ozone exposure, vitamin C intake, and genetic susceptibility of asthmatic children in Mexico City: a cohort study. Respir Res 2013; 14: 14.

    Article  Google Scholar 

  14. Barraza-Villarreal A, Sunyer J, Hernandez-Cadena L, Escamilla-Nuñez MC, Sienra-Monge JJ, Ramírez-Aguilar M et al. Air pollution, airway inflammation, and lung function in a cohort study of Mexico City schoolchildren. Environ Health Perspect 2008; 116: 832–838.

    Article  Google Scholar 

  15. Just J, Ségala C, Sahraoui F, Priol G, Grimfeld A, Neukirch F . Short-term health effects of particulate and photochemical air pollution in asthmatic children. Eur Respir J 2002; 20: 899–906.

    Article  CAS  Google Scholar 

  16. Ross MA, Persky VW, Scheff PA, Chung J, Curtis L, Ramakrishnan V et al. Effect of ozone and aeroallergens on the respiratory health of asthmatics. Arch Environ Health 2002; 57: 568–578.

    Article  CAS  Google Scholar 

  17. Kim CS, Alexis NE, Rappold AG, Kehrl H, Hazucha MJ, Lay JC et al. Lung function and inflammatory responses in healthy young adults exposed to 0.06 ppm ozone for 6.6 hours. Am J Respir Crit Care Med 2011; 183: 1215–1221.

    Article  Google Scholar 

  18. Scarlett JF, Abbott KJ, Peacock JL, Strachan DP, Anderson HR . Acute effects of summer air pollution on respiratory function in primary school children in southern England. Thorax 1996; 51: 1109–1114.

    Article  CAS  Google Scholar 

  19. Chen C, Arjomandi M, Tager IB, Holland N, Balmes JR . Effects of antioxidant enzyme polymorphisms on ozone-induced lung function changes. Eur Respir J 2007; 30: 677–683.

    Article  CAS  Google Scholar 

  20. Kelly FJ . Dietary antioxidants and environmental stress. Proc Nutr Soc 2004; 63: 579–585.

    Article  CAS  Google Scholar 

  21. Mudway IS, Kelly FJ . Ozone and the lung: a sensitive issue. Mol Aspects Med 2000; 21: 1–48.

    Article  CAS  Google Scholar 

  22. Kelly FJ . Vitamins and respiratory disease: antioxidant micronutrients in pulmonary health and disease. Proc Nutr Soc 2005; 64: 510–526.

    Article  CAS  Google Scholar 

  23. Que LG, Stiles JV, Sundy JS, Foster WM . Pulmonary function, bronchial reactivity, and epithelial permeability are response phenotypes to ozone and develop differentially in healthy humans. J Appl Physiol 1985; 111: 679–687.

    Article  Google Scholar 

  24. Monn C . Exposure assessment of air pollutants: a review on spatial heterogeneity and indoor/outdoor/personal exposure to suspended particulate matter, nitrogen dioxide and ozone. Atmos Environ 2000; 35: 1–32.

    Article  CAS  Google Scholar 

  25. McConnell R, Islam T, Shankardass K, Jerrett M, Lurmann F, Gilliland F et al. Childhood incident asthma and traffic-related air pollution at home and school. Environ Health Perspect 2010; 118: 1021–1026.

    Article  CAS  Google Scholar 

  26. Li S, Williams G, Jalaludin B, Baker P . Panel studies of air pollution on children's lung function and respiratory symptoms: a literature review. J Asthma 2012; 49: 895–910.

    Article  Google Scholar 

  27. Gerrity TR, Weaver RA, Bernsten J, House DE, O’Neil JJ . Extrathoracic and intrathoracic removal of O3 in tidal-breathing humans. J Appl Physiol 1988; 65: 393–400.

    Article  CAS  Google Scholar 

  28. Frischer TM, Kuehr J, Pullwitt A, Meinert R, Forster J, Studnicka M et al. Ambient ozone causes upper airways inflammation in children. Am Rev Respir Dis 1993; 148: 961–964.

    Article  CAS  Google Scholar 

  29. Karakatsani A, Kapitsimadis F, Pipikou M, Chalbot M-C, Kavouras IG, Orphanidou D et al. Ambient air pollution and respiratory effects in mail carriers. Environ Res 2010; 110: 278–285.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The work has been co-funded by the European Commission and the Greek government by the National Strategic Reference Framework 2007-2013 Contract Ref: RESPOZE-children/2248.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Evangelia Samoli.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Supplementary Information accompanies the paper on the Journal of Exposure Science and Environmental Epidemiology website

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Samoli, E., Dimakopoulou, K., Evangelopoulos, D. et al. Is daily exposure to ozone associated with respiratory morbidity and lung function in a representative sample of schoolchildren? Results from a panel study in Greece. J Expo Sci Environ Epidemiol 27, 346–351 (2017). https://doi.org/10.1038/jes.2016.32

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jes.2016.32

Keywords

  • air pollution
  • children
  • ozone
  • panel
  • respiratory health

This article is cited by

Search

Quick links