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Asthma and
Air Pollution

A guide for health professionals
Introduction 
Health effects of outdoor air pollution

Reducing exposure to outdoor pollutants

Outdoor air pollutants
Health effects of indoor air pollution

Reducing exposure to indoor air pollutants
Indoor air pollutants
Current issues
Information resources
Levels of evidence
References
Appendices

Authors

Disclaimer

Further information
Content created MAR 2005
Content updated MAR 2005

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NextBackLevels of evidence

I           Evidence obtained from a systematic review of all relevant randomised controlled trials
II Evidence obtained from at least one properly designed randomised controlled trial
III-1 Evidence obtained from well-designed pseudo-randomised controlled trials (alternate allocation or some other method)
III-2 Evidence obtained from comparative studies with concurrent controls and allocation not randomised (cohort studies), case-control studies, or interrupted time series with a control group
III-3 Evidence obtained from comparative studies with historical control, two or more single-arm studies, or interrupted time series without a parallel control group
IV Evidence obtained from case series, either post-test or pre-test and post-test  

These levels of evidence ratings have been adapted from US Preventive Services Task Force (1989) Guide to clinical preventive services: an assessment of the effectiveness of 169 interventions (ed M Fisher), Williams and Williams, Baltimore, Appendix A, p 388.

Source: NHMRC
A guide to the development, implementation and evaluation of clinical practice guidelines.

References

1 Atkinson RW, Anderson HR, Sunyer J, Ayres J, Baccini M, Vonk JM, Boumghar A, Forastiere F, Forsberg B, Touloumi G, Schwartz J, Katsouyanni K (2001). Acute effects of particulate air pollution on respiratory admissions: results from APHEA 2 project. Air Pollution and Health: a European Approach. American Journal of Respiratory & Critical Care Medicine. 164(10 Pt 1): 1860-6.
2 Morgan G, Corbett S, Wlodarczyk JH (1998). Air Pollution and Hospital Admissions in Sydney, Australia, 1990 to 1994. American Journal of Public Health 88(12): 1761-1766.
3 Petroeschevsky A, Simpson RW, Thalib L, Rutherford S (2001). Associations between outdoor air pollution and hospital admissions in Brisbane, Australia. Archives of Environmental Health. 56(1): 37-52.
4 Denison L, Simpson R, Petroeschevsky A, Thalib L, Williams G (2001). Ambient air pollution and daily hospital admissions in Melbourne 1994-1997. Melbourne, Environment Protection Authority: 84.
5 Johnston FH, Kavanagh AM, Bowman DM, Scott RK (2002). Exposure to bushfire smoke and asthma: an ecological study. Medical Journal of Australia. 176(11): 535-8.
6 Roemer W, Clench-Aas J, Englert N, Hoek G, Katsouyanni K, Pekkanen J, Brunekreef B (1999). Inhomogeneity in response to air pollution in European children (PEACE project). Occupational & Environmental Medicine. 56(2): 86-92.
7 McConnell R, Berhane K, Gilliland F, London SJ, Islam T, Gauderman WJ, Avol E, Margolis HG, Peters JM (2002). Asthma in exercising children exposed to ozone: a cohort study. Lancet. 359(9304): 386-91.
8 Kehrl HR, Peden DB, Ball B, Folinsbee LJ, Horstman D (1999). Increased specific airway reactivity of persons with mild allergic asthma after 7.6 hours of exposure to 0.16 ppm ozone. Journal of Allergy & Clinical Immunology. 104(6): 1198-204.
9 Newson EJ, Krishna MT, Lau LC, Howarth PH, Holgate ST, Frew AJ (2000). Effects of short-term exposure to 0.2 ppm ozone on biomarkers of inflammation in sputum, exhaled nitric oxide, and lung function in subjects with mild atopic asthma. Journal of Occupational & Environmental Medicine. 42(3): 270-7.
10 Stenfors N, Pourazar J, Blomberg A, Krishna MT, Mudway I, Helleday R, Kelly FJ, Frew AJ, Sandstrom T (2002). Effect of ozone on bronchial mucosal inflammation in asthmatic and healthy subjects. Respiratory Medicine. 96(5): 352-8.
11 Molfino NA, Wright SC, Katz I, Tarlo S, Silverman F, McClean PA, Szalai JP, Raizenne M, Slutsky AS, Zamel N (1991). Effect of low concentrations of ozone on inhaled allergen responses in asthmatic subjects. Lancet 338: 199-203.
12 Tunnicliffe WS, Burge PS, Ayres JG (1994). Effect of domestic concentrations of nitrogen dioxide on airway responses to inhaled allergen in asthmatic patients. Lancet 344: 1733-1736.
13 Pope CA, 3rd, Burnett RT, Thun MJ, Calle EE, Krewski D, Ito K, Thurston GD (2002). Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution. JAMA 287(9): 1132-41.
14 Reese, A. C., I. R. James, L. I. Landau and P. N. Lesouef (1992). Relationship between urinary cotinine level and diagnosis in children admitted to hospital. American Review of Respiratory Disease. 146(1): 66-70.
15 Haby, M. M., J. K. Peat and A. J. Woolcock (1994). Effect of passive smoking, asthma, and respiratory infection on lung function in Australian children. Pediatric Pulmonology. 18(5): 323-9.
16 Eisner, M. D., E. H. Yelin, P. P. Katz, G. Earnest and P. D. Blanc (2002). Exposure to indoor combustion and adult asthma outcomes: environmental tobacco smoke, gas stoves, and wood smoke. Thorax 57(11): 973-978.
17 Coultas, D. B. (1998). Passive smoking and risk of adult asthma and COPD: an update. Thorax 53: 381–7.
18 Abbey, D. E., F. Petersen, P. K. Mills and W. L. Beeson (1993). Long-term ambient concentrations of total suspended particulates, ozone and sulfur dioxide and respiratory symptoms in a non-smoking population. Archive of Environmental Health 48: 33–47.
19 Garrett, M. H., M. A. Hooper, B. M. Hooper and M. J. Abramson (1998). Respiratory Symptoms in Children and Indoor Exposure to Nitrogen Dioxide and Gas Stoves. American Journal of Respiratory Critical care Care Medicine 158(3): 891-895.
20 Krzyzanowski, M., J. J. Quackenboss and M. D. Lebowitz (1990). Chronic respiratory effects of indoor formaldehyde exposure. Environmental Research 52(2): (117-25.
21 Norback, D., E. Bjornsson, C. Janson, J. Widstrom and G. Boman (1995). Asthmatic symptoms and volatile organic compounds, formaldehyde, and carbon dioxide in dwellings. Occupational and Environmental Medicine 52(6): 388-395.
22 Pilotto, L. S., R. M. Douglas, R. G. Attewell and S. R. Wilson (1997). Respiratory effects associated with indoor nitrogen dioxide exposure in children.” International Journal of Epidemiology. 26(4): 788-96.
23 Volkmer, R. E., R. E. Ruffin, N. R. Wigg and N. Davies (1995). The prevalence of respiratory symptoms in South Australian preschool children. II. Factors associated with indoor air quality.  Journal of Paediatrics & Child Health 31(2): 116-20.
24 Smith, B. J., M. Nitschke, L. S. Pilotto, et al. (2000). Health effects of daily indoor nitrogen dioxide exposure in people with asthma. European Respiratory Journal 16(5): 879-85.
25 Triche, E. W., K. Belanger, W. Beckett, et al. (2002). Infant Respiratory Symptoms Associated with Indoor Heating Sources. American Journal of Respiratory and Critical Care Medicine 166(8): 1105-1111.
26 Pilotto L, Nitschke M, Smith BJ, Pisaniello D, Ruffin RE, McElroy HJ, Martin AJ, Hiller J (2004). Randomized controlled trial of unflued gas heater replacement on respiratory health of asthmatic schoolchildren. Int J Epidemiol 33(1): 208-214.
27 Beach, J. R., J. Raven, C. Ingram, et al. (1997). The effects on asthmatics of exposure to a conventional water-based and a volatile organic compound-free paint. European Respiratory Journal 10(3): 563-6.

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