title: Association between personal exposure to ambient metals and respiratory disease in Italian adolescents: a cross-sectional study.
abstract: BACKGROUND
  Release of ambient metals during ferroalloy production may be an important source of environmental exposure for nearby communities and exposure to these metals has been linked to adverse respiratory outcomes. We sought to characterize the association between personal air levels of metals and respiratory health in Italian adolescents living in communities with historic and current ferroalloy activity.
  
  
  METHODS
  As part of a study in the industrial province of Brescia, Italy, 410 adolescents aged 11-14 years were recruited. Participants were enrolled from three different communities with varying manganese (Mn) levels: Bagnolo Mella which has current ferroalloy activity, Valcamonica, which has historic ferroalloy activity and Garda Lake which has no history of ferroalloy activity. Particulate matter <10 μm in diameter (PM10) was collected for 24 h in filters using personal sampling. Mn, nickel (Ni), zinc (Zn), chromium (Cr) and iron (Fe) were measured in filters using x-ray fluorescence. Data on respiratory health was collected through questionnaire. Data for 280 adolescents were analyzed using a modified Poisson regression, and risk ratios were calculated for an interquartile (IQR) range increase in each pollutant.
  
  
  RESULTS
  In adjusted models including PM10 as a co-pollutant, we found significant associations between concentrations of Mn (RR: 1.09, 95% CI [1.00, 1.18] per 42 ng/m(3) increase), Ni (RR: 1.11, 95% CI [1.03, 1.21] per 4 ng/m(3) increase) and Cr (RR: 1.08, 95% CI [1.06, 1.11] per 9 ng/m(3) increase) and parental report of asthma. We also found significant associations between increased Mn and Ni and increased risk of asthma medication use in the past 12 months (RR: 1.13, 95% CI [1.04, 1.29] and (RR: 1.13, 95 % CI [1.01, 1.27] respectively).
  
  
  CONCLUSIONS
  Our findings suggest that exposure to ambient Mn, Ni and Cr may be associated with adverse respiratory outcomes.
authors.affiliation: Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA. maria.rosa@mssm.edu.
authors.forename: Maria José
authors.initials: MJ
authors.lastname: Rosa
authors.affiliation: Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Section of Occupational Medicine, University of Brescia, Brescia, Italy. chiara.benedetti@neurotoxmet.org.
authors.forename: Chiara
authors.initials: C
authors.lastname: Benedetti
authors.affiliation: Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Section of Occupational Medicine, University of Brescia, Brescia, Italy. marco.peli@neurotoxmet.org.|Department of Civil, Environmental, Architectural Engineering and Mathematics of the University of Brescia, Brescia, Italy. marco.peli@neurotoxmet.org.
authors.forename: Marco
authors.initials: M
authors.lastname: Peli
authors.affiliation: Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Section of Occupational Medicine, University of Brescia, Brescia, Italy. filippo.donna@gmail.com.
authors.forename: Filippo
authors.initials: F
authors.lastname: Donna
authors.affiliation: Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Section of Occupational Medicine, University of Brescia, Brescia, Italy. marconazzaro@tiscali.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Nazzaro
authors.affiliation: Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Section of Occupational Medicine, University of Brescia, Brescia, Italy. chiara.fedrighi@neurotoxmet.org.
authors.forename: Chiara
authors.initials: C
authors.lastname: Fedrighi
authors.affiliation: Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Section of Occupational Medicine, University of Brescia, Brescia, Italy. silvia.zoni@unibs.it.
authors.forename: Silvia
authors.initials: S
authors.lastname: Zoni
authors.affiliation: Department of Diagnostics and Public Health, Unit of Epidemiology & Medical Statistics, University of Verona, Verona, Italy. alessandro.marcon@univr.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Marcon
authors.affiliation: School of Health Sciences, Purdue University, West Lafayette, IN, USA. neil@purdue.edu.
authors.forename: Neil
authors.initials: N
authors.lastname: Zimmerman
authors.affiliation: Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA. rosalind.wright@mssm.edu.|Department of Pediatrics, Pulmonary and Critical Care, Icahn School of Medicine at 'Mount Sinai, New York, NY, USA. rosalind.wright@mssm.edu.
authors.forename: Rosalind
authors.initials: R
authors.lastname: Wright
authors.affiliation: Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA. roberto.lucchini@mssm.edu.|Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Section of Occupational Medicine, University of Brescia, Brescia, Italy. roberto.lucchini@mssm.edu.
authors.forename: Roberto
authors.initials: R
authors.lastname: Lucchini
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000453:epidemiology*; D016022:Case-Control Studies; D002648:Child; D002857:Chromium; D003430:Cross-Sectional Studies; D004781:Environmental Exposure / Q000706:statistics & numerical data*; D004784:Environmental Monitoring; D005260:Female; D006801:Humans; D007501:Iron; D007558:Italy / Q000453:epidemiology; D008297:Male; D008345:Manganese; D008670:Metals; D009532:Nickel; D052638:Particulate Matter; D012140:Respiratory Tract Diseases / Q000453:epidemiology; D012307:Risk Factors; D015032:Zinc
chemical_list: D008670:Metals; D052638:Particulate Matter; D002857:Chromium; D008345:Manganese; D009532:Nickel; D007501:Iron; D015032:Zinc