Lagged acute respiratory outcomes among children related to ambient pollutant exposure in a high exposure setting in South Africa.

Acute ambient air pollution impacts on the respiratory health of children may be lagged across time. We determined the short-term lagged effects of particulate matter (PM_2.5), sulphur dioxide (SO₂), and oxides of nitrogen (NO_x) on the respiratory health of children living in low-income communities.

Methods: A school-based study was conducted using a repeated measures design, across summer and winter, in four schools in each of four suburbs in the Vaal Triangle, South Africa. Data for PM_2.5, NO_x, and SO₂ were obtained from monitoring stations within close proximity of the schools. Over 10 school days in each phase, grade 4 children completed a symptoms log and lung function tests. Parents completed a child respiratory questionnaire. Generalized estimation equations models adjusted for covariates of interest in relation to lung function outcomes and air pollutants including lag effects of 1-5 days.

Results: Daily PM_2.5, NO_x, and SO₂ median concentration levels were frequently higher than international standards. Among the 280 child participants (mean age 9 years), the prevalence of symptoms based on probable asthma was 9.6%. There was a consistent increased pollutant-related risk for respiratory symptoms, except for NO_x and shortness of breath. Lung function, associated with pollutant fluctuations across the different lags, was most pronounced for peak expiratory flow rate (PEFR) for PM_2.5 and SO₂. A preceding 5-day average SO₂ exposure had the largest loss (7.5 L/minute) in PEFR.

Conclusions: Lagged declines in daily lung function and increased odds of having respiratory symptoms were related to increases in PM_2.5 and SO₂ among a school-based sample of children.