The Australian Child Health and Air Pollution Study (ACHAPS): A National Population-based Cross-sectional Study of Long-term Exposure to Outdoor Air Pollution, Asthma, and Lung Function

Most studies of long-term air pollution exposure and children's respiratory health have been performed in urban locations with moderate pollution levels. We assessed the effect of outdoor nitrogen dioxide (NO), as a proxy for urban air pollution, on current asthma and lung function in Australia, a low-pollution setting. We undertook a national population-based cross-sectional study of children aged 7-11 years living in 12 Australian cities. We collected information on asthma symptoms from parents via questionnaire and measured children's lung function (forced expiratory volume in 1 s [FEV], forced vital capacity [FVC]) and fractional exhaled nitric oxide [Fe]). We estimated recent NO exposure (last 12 months) using monitors near each child's school, and used a satellite-based land-use regression (LUR) model to estimate NO at each child's school and home. Our analysis comprised 2630 children, among whom the prevalence of current asthma was 14.9%. Mean (±SD) NO exposure was 8.8 ppb (±3.2) and 8.8 ppb (±2.3) for monitor- and LUR-based estimates, respectively. Mean percent predicted post-bronchodilator FEV and FVC were 101.7% (±10.5) and 98.8% (±10.5), respectively. The geometric mean Fe concentration was 9.4 ppb (±7.1). An IQR increase in NO (4.0 ppb) was significantly associated with increased odds of having current asthma; odds ratios (ORs) were 1.24 (95% CI: 1.08, 1.43) and 1.54 (95% CI: 1.26, 1.87) for monitor- and LUR-based estimates, respectively. Increased NO exposure was significantly associated with decreased percent predicted FEV (-1.35 percentage points [95% CI: -2.21, -0.49]) and FVC (-1.19 percentage points [95% CI: -2.04, -0.35], and an increase in Fe of 71% (95% CI: 38%, 112%). Exposure to outdoor NO was associated with adverse respiratory health effects in this population-based sample of Australian children. The relatively low NO levels at which these effects were observed highlight the potential benefits of continuous exposure reduction.