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Am. J. Respir. Crit. Care Med., Volume 159, Number 4, April 1999, 1257-1266

Long-Term Ambient Air Pollution and Respiratory Symptoms in Adults (SAPALDIA Study)

ELIZABETH ZEMP, SERGE ELSASSER, CHRISTIAN SCHINDLER, NINO KÜNZLI, ANDRÉ P. PERRUCHOUD, GUIDO DOMENIGHETTI, TULLIO MEDICI, URSULA ACKERMANN-LIEBRICH, PHILIPP LEUENBERGER, CHRISTIAN MONN, GIANFRANCO BOLOGNINI, JEAN-PIERRE BONGARD, OTTO BRÄNDLI, WERNER KARRER, ROLAND KELLER, MARTIN H. SCHÖNI, JEAN-MARIE TSCHOPP, BEA VILLIGER, JEAN-PIERRE ZELLWEGER, and the SAPALDIA Team

Institute of Social and Preventive Medicine, University of Basel, Basel; Division of Pneumology, University of Lausanne, Lausanne; Federal Institute of Technology, Zürich, Switzerland; and the SAPALDIA Team

The association between long-term exposure to ambient air pollution and respiratory symptoms was investigated in a cross-sectional study in random population samples of adults (aged 18 to 60 yr, n = 9,651) at eight study sites in Switzerland. Information on respiratory symptoms was obtained with an extended version of the European Community Respiratory Health Survey questionnaire. The impact of annual mean concentrations of air pollutants was analyzed separately for never-, former, and current smokers. After controlling for age, body mass index, gender, parental asthma, parental atopy, low education, and foreign citizenship, we found positive associations between annual mean concentrations of NO2, total suspended particulates, and particulates of less than 10 µm in aerodynamic diameter (PM10) and reported prevalences of chronic phlegm production, chronic cough or phlegm production, breathlessness at rest during the day, breathlessness during the day or at night, and dyspnea on exertion. We found no associations with wheezing without cold, current asthma, chest tightness, or chronic cough. Among never-smokers, the odds ratio (95% confidence interval) for a 10 µg/ m3 increase in the annual mean concentration of PM10 was 1.35 (1.11 to 1.65) for chronic phlegm production, 1.27 (1.08 to 1.50) for chronic cough or phlegm production, 1.48 (1.23 to 1.78) for breathlessness during the day, 1.33 (1.14 to 1.55) for breathlessness during the day or at night, and 1.32 (1.18 to 1.46) for dyspnea on exertion. No associations were found with annual mean concentrations of O3. Similar associations were also found for former and current smokers, except for chronic phlegm production. The observed associations remained stable when further control was applied for environmental tobacco smoke exposure, past and current occupational exposures, atopy, and early childhood respiratory infections when restricting the analysis to long-term residents and to non- alpine areas, and when excluding subjects with physician-diagnosed asthma. The high correlation between the pollutants makes it difficult to sort out the effect of one single pollutant. This study provides further evidence that long-term exposure to air pollution of rather low levels is associated with higher prevalences of respiratory symptoms in adults.




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