title: Particulate matter air pollution and respiratory symptoms in individuals having either asthma or chronic obstructive pulmonary disease: a European multicentre panel study.
abstract: BACKGROUND
  Particulate matter air pollution has been associated with adverse health effects. The fraction of ambient particles that are mainly responsible for the observed health effects is still a matter of controversy. Better characterization of the health relevant particle fraction will have major implications for air quality policy since it will determine which sources should be controlled.The RUPIOH study, an EU-funded multicentre study, was designed to examine the distribution of various ambient particle metrics in four European cities (Amsterdam, Athens, Birmingham, Helsinki) and assess their health effects in participants with asthma or COPD, based on a detailed exposure assessment. In this paper the association of central site measurements with respiratory symptoms and restriction of activities is examined.
  
  
  METHODS
  At each centre a panel of participants with either asthma or COPD recorded respiratory symptoms and restriction of activities in a diary for six months. Exposure assessment included simultaneous measurements of coarse, fine and ultrafine particles at a central site. Data on gaseous pollutants were also collected. The associations of the 24-hour average concentrations of air pollution indices with the health outcomes were assessed in a hierarchical modelling approach. A city specific analysis controlling for potential confounders was followed by a meta-analysis to provide overall effect estimates.
  
  
  RESULTS
  A 10 μg/m3 increase in previous day coarse particles concentrations was positively associated with most symptoms (an increase of 0.6 to 0.7% in average) and limitation in walking (OR= 1.076, 95% CI: 1.026-1.128). Same day, previous day and previous two days ozone concentrations were positively associated with cough (OR= 1.061, 95% CI: 1.013-1.111; OR= 1.049, 95% CI: 1.016-1.083 and OR= 1.059, 95% CI: 1.027-1.091, respectively). No consistent associations were observed between fine particle concentrations, nitrogen dioxide and respiratory health effects. As for particle number concentrations negative association (mostly non-significant at the nominal level) was observed with most symptoms whilst the positive association with limitation of activities did not reach the nominal level of significance.
  
  
  CONCLUSIONS
  The observed associations with coarse particles are in agreement with the findings of toxicological studies. Together they suggest it is prudent to regulate also coarse particles in addition to fine particles.
authors.affiliation: 2nd Department of Respiratory Medicine, National and Kapodistrian University of Athens, Haidari, Greece. annakara@otenet.gr
authors.forename: Anna
authors.initials: A
authors.lastname: Karakatsani
authors.forename: Antonis
authors.initials: A
authors.lastname: Analitis
authors.forename: Dimitra
authors.initials: D
authors.lastname: Perifanou
authors.forename: Jon G
authors.initials: JG
authors.lastname: Ayres
authors.forename: Roy M
authors.initials: RM
authors.lastname: Harrison
authors.forename: Anastasia
authors.initials: A
authors.lastname: Kotronarou
authors.forename: Ilias G
authors.initials: IG
authors.lastname: Kavouras
authors.forename: Juha
authors.initials: J
authors.lastname: Pekkanen
authors.forename: Kaarle
authors.initials: K
authors.lastname: Hämeri
authors.forename: Gerard Pa
authors.initials: GP
authors.lastname: Kos
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: de Hartog
authors.forename: Gerard
authors.initials: G
authors.lastname: Hoek
authors.forename: Klea
authors.initials: K
authors.lastname: Katsouyanni
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000393:Air Pollutants / Q000032:analysis / Q000633:toxicity; D000397:Air Pollution / Q000009:adverse effects* / Q000032:analysis; D001249:Asthma / Q000139:chemically induced* / Q000453:epidemiology; D002947:Cities; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009585:Nitrogen Dioxide / Q000032:analysis / Q000633:toxicity; D016017:Odds Ratio; D010126:Ozone / Q000032:analysis / Q000633:toxicity; D052638:Particulate Matter / Q000032:analysis / Q000633:toxicity*; D029424:Pulmonary Disease, Chronic Obstructive / Q000139:chemically induced* / Q000453:epidemiology; D012120:Respiration Disorders / Q000139:chemically induced* / Q000453:epidemiology; D016138:Walking
chemical_list: D000393:Air Pollutants; D052638:Particulate Matter; D010126:Ozone; D009585:Nitrogen Dioxide