title: 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 O3exposure - 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/m3increase in O3personal 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 O3exposure. 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 O3exposure may be associated with respiratory symptoms extending previously reported results for asthmatics to the general population.
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
authors.forename: Evangelia
authors.initials: E
authors.lastname: Samoli
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
authors.forename: Konstantina
authors.initials: K
authors.lastname: Dimakopoulou
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Evangelopoulos
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
authors.forename: Sophia
authors.initials: S
authors.lastname: Rodopoulou
authors.affiliation: 2nd Pulmonary Department, "ATTIKON" University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Anna
authors.initials: A
authors.lastname: Karakatsani
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
authors.forename: Lambrini
authors.initials: L
authors.lastname: Veneti
authors.affiliation: Pulmonary Department, G. Papanikolaou Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Sionidou
authors.affiliation: Pulmonary Department, G. Papanikolaou Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Tsolakoglou
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Krasanaki
authors.affiliation: School of Chemical Engineering, National Technical University of Athens, Athens, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Grivas
authors.affiliation: Pulmonary Department, G. Papanikolaou Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Despoina
authors.initials: D
authors.lastname: Papakosta
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, Athens, Greece.|Department of Primary Care & Public Health Sciences and Environmental Research Group, King's College, London.
authors.forename: Klea
authors.initials: K
authors.lastname: Katsouyanni
mesh_terms: D000041:Absenteeism; D000393:Air Pollutants / Q000009:adverse effects* / Q000032:analysis; D000397:Air Pollution / Q000009:adverse effects* / Q000032:analysis; D001249:Asthma; D002648:Child; D003371:Cough; D004784:Environmental Monitoring; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D015508:Nasal Obstruction; D010126:Ozone / Q000009:adverse effects* / Q000032:analysis; D010366:Peak Expiratory Flow Rate; D012140:Respiratory Tract Diseases / Q000139:chemically induced* / Q000453:epidemiology*
chemical_list: D000393:Air Pollutants; D010126:Ozone