Ambient nitrogen oxides exposure and early childhood respiratory illnesses

Rakesh Ghosh, Jesse Joad, Ivan Benes, Miroslav Dostal, Radim J. Sram, Irva Hertz-Picciotto

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Acute respiratory infections are common in children below 5years and recent studies suggest a possible link with air pollution. In this study, we investigated the association between ambient nitrogen oxides (NO x) and bronchitis or upper airway inflammation.This longitudinal study was conducted in Teplice and Prachatice districts, Czech Republic. Children were followed from birth to 4.5. years of age. Data were compiled from medical records at delivery and at follow up, and from self-administered questionnaires from the same two time points. Air pollution monitoring data were used to estimate exposure over five different averaging periods ranging from three to 45. days prior to an episode. To quantify the association between exposure and outcome, while accounting for repeated measure correlation we conducted logistic regression analysis using generalized estimating equations.During the first 2years of life, the adjusted rate ratio for bronchitis associated with interquartile increase in the 30-day average NO x was 1.31 [95% confidence interval (CI): 1.07, 1.61] and for two to 4.5year olds, it was 1.23 (95% CI: 1.01, 1.49). The 14-day exposure also had stable association across both age groups: below 2years it was 1.25 (95% CI: 1.06, 1.47) and for two to 4.5years it was 1.21 (95% CI: 1.06, 1.39). The association between bronchitis and NO x increased with child's age in the under 2years group, which is a relatively novel finding.The results demonstrate an association between NO x and respiratory infections that are sufficiently severe to come to medical attention. The evidence, if causal, can be of public health concern because acute respiratory illnesses are common in preschool children.

Original languageEnglish (US)
Pages (from-to)96-102
Number of pages7
JournalEnvironment international
Issue number1
StatePublished - Feb 2012


  • Air pollution
  • Bronchitis
  • Croup
  • Effect modification
  • LRI

ASJC Scopus subject areas

  • Environmental Science(all)


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