Background: Air pollution has many negative health effects on the general population, especially children, subjects\nwith underlying chronic disease and the elderly. The aims of this study were to evaluate the effects of traffic-related\npollution on the exacerbation of asthma and development of respiratory infections in Italian children suffering\nfrom asthma or wheezing compared with healthy subjects and to estimate the association between incremental\nincreases in principal pollutants and the incidence of respiratory symptoms.\nMethods: This prospective study enrolled 777 children aged 2 to 18 years (375 with recurrent wheezing or asthma\nand 402 healthy subjects). Over 12 months, parents filled out a daily clinical diary to report information about\nrespiratory symptoms, type of medication used and healthcare utilization. Clinical data were combined with the\nresults obtained using an air pollution monitoring system of the five most common pollutants.\nResults: Among the 329 children with recurrent wheezing or asthma and 364 healthy subjects who completed\nfollow-up, children with recurrent wheezing or asthma reported significantly more days of fever (p = 0.005) and\ncough (p < 0.001), episodes of rhinitis (p = 0.04) and tracheitis (p = 0.01), asthma attacks (p < 0.001), episodes of\npneumonia (p < 0.001) and hospitalizations (p = 0.02). In the wheezing/asthma cohort, living close to the street with\na high traffic density was a risk factor for asthma exacerbations (odds ratio [OR] = 1.79; 95% confidence interval [CI],\n1.13-2.84), whereas living near green areas was found to be protective (OR = 0.50; 95% CI, 0.31 -0.80). An increase of\n10 ?g/m3 of particulates less than 10 microns in diameter (PM10) and nitrogen dioxide (NO2) increased the onset\nof pneumonia only in wheezing/asthmatic children (continuous rate ratio [RR] = 1.08, 95% CI: 1.00-1.17 for PM10;\ncontinuous RR = 1.08, 95% CI: 1.01-1.17 for NO2).\nConclusions: There is a significant association between traffic-related pollution and the development of asthma\nexacerbations and respiratory infections in children born to atopic parents and in those suffering from recurrent\nwheezing or asthma. These findings suggest that environmental control may be crucial for respiratory health in\nchildren with underlying respiratory disease.
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