Impact of School Air Quality on Children's Respiratory Health

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Abstract

Background:

Asthma is common in children with indoor pollutants influencing the development of the disease. Since children spend most of their time outside their homes within the school environment, school indoor air quality can directly influence their respiratory health.

Aims:

This study aims to analyze the indoor and outdoor air quality of Maltese schools and if an association exists between indoor pollutants and respiratory health in children.

Settings and Design:

Five primary schools were selected with 9- to 11-year-old students participating.

Materials and Methods:

Standardized health questionnaires and lung function tests were utilized. Indoor and outdoor air sampling together with traffic counts were carried out.

Statistical Analysis Used:

SPSS version 21 was used and the Chi-squared, logistic regression, and Pearson's correlation were used.

Results:

The mean indoor PM 2.5 level of 17.78 μg/m ³ and CO (9.11 ppm) exceeded World Health Organization thresholds. Indoor ozone levels exceeded the mean European school's indoor ozone concentration of 8 μg/m ³. High exposure to formaldehyde, NO ₂, and ozone was associated with atopy in children. Heavy vehicles passing near the schools were associated with current wheezing ( P < 0.001) but not nocturnal cough ( P = 0.34).

Conclusions:

School indoor and outdoor environment has a direct impact on children's respiratory health. This study has identified significant associations between high exposures to indoor air pollutants, school characteristics, and upper and lower airway inflammation.

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Most cited references 22

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Long-term exposure to close-proximity air pollution and asthma and allergies in urban children.

I Annesi-Maesano, C Kopferschmitt, D Caillaud … (2010)

The aim of this study was to evaluate the impact of urban air pollution, assessed through reliable indicators of exposure, on asthma and allergies in schoolchildren. A validated dispersion model combining data on traffic conditions, topography, meteorology and background pollution was used to relate 3-yrs averaged concentrations of major urban pollutants at the sites of schools to skin prick tests, exercise-induced asthma and reported asthma and allergies in 6,683 children (9-11 yrs) attending 108 schools randomly selected in six French communities. For the 4,907 children who had resided at their current address for the past 3 yrs, asthma (exercise induced, past year and lifetime) was significantly positively associated with benzene, SO(2), particles with a 50% cut-off aerodynamic diameter of 10 microm (PM(10)), nitrogen oxides (NO(x)) and CO. In the same children, eczema (lifetime and past year) was significantly positively associated with benzene, PM(10), NO(2), NO(x) and CO, lifetime allergic rhinitis with PM(10) and sensitisation to pollens with benzene and PM(10). Among the 2,213 children residing at their current address since birth, the associations persisted for lifetime asthma with benzene (adjusted OR per interquartile range (95% CI) 1.3 (1.0-1.9)) and PM(10 )(1.4 (1.0-2.0)), and for sensitisation to pollens with volatile organic compounds (1.3 (1.0-1.9)) and PM(10) (1.2 (1.0-1.9)). Accurately modelled urban air pollution was associated with some measures of childhood asthma and allergies.

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Poor air quality in classrooms related to asthma and rhinitis in primary schoolchildren of the French 6 Cities Study

Isabella Annesi-Maesano, Marion Hulin, François Lavaud … (2012)

Background Relationships between indoor air quality (IAQ) found in schools and the allergic and respiratory health of schoolchildren have been insufficiently explored. A survey was conducted in a large sample of classrooms of primary schools in France to provide objective assessments of IAQ to which young schoolchildren are exposed in classrooms, and to relate exposure to major air pollutants found in classrooms to asthma and allergies of schoolchildren. Methods Concentrations of fine particles with aerodynamic diameter ≤2.5 μm (PM2.5), nitrogen dioxide (NO2) and three aldehydes were objectively assessed in 401 randomly chosen classrooms in 108 primary schools attended by 6590 children (mean age 10.4 years, SD ±0.7) in the French 6 Cities Study. The survey incorporated a medical visit including skin prick testing (SPT) for common allergens, a test for screening exercise-induced asthma (EIA) and a standardised health questionnaire completed by parents. Results Children were differently exposed to poor air quality in classrooms, with almost 30% being highly exposed according to available standards. After adjusting for confounders, past year rhinoconjunctivitis was significantly associated with high levels of formaldehyde in classrooms (OR 1.19; 95% CI 1.04 to 1.36). Additionally, an increased prevalence of past year asthma was found in the classrooms with high levels of PM2.5 (OR 1.21; 95% CI 1.05 to 1.39), acrolein (OR 1.22; 95% CI 1.09 to 1.38) and NO2 (OR 1.16; 95% CI 0.95 to 1.41) compared with others. The relationship was observed mostly for allergic asthma as defined using SPT. A significant positive correlation was found between EIA and the levels of PM2.5 and acrolein in the same week. Conclusions In this random sample, air quality in classrooms was poor, varied significantly among schools and cities, and was related to an increased prevalence of clinical manifestations of asthma and rhinitis in schoolchildren. Children with a background of allergies seemed at increased risk.

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Current asthma and respiratory symptoms among pupils in Shanghai, China: influence of building ventilation, nitrogen dioxide, ozone, and formaldehyde in classrooms.

Michael Y Mi, M Ferm, D Norbäck … (2006)

We investigated 10 naturally ventilated schools in Shanghai, in winter. Pupils (13-14 years) in 30 classes received a questionnaire, 1414 participated (99%). Classroom temperatures were 13-21 degrees C (mean 17 degrees C), relative air humidity was 36-82% (mean 56%). The air exchange rate was 2.9-29.4 ac/h (mean 9.1), because of window opening. Mean CO2 exceeded 1000 ppm in 45% of the classrooms. NO2 levels were 33-85 microg/m3 indoors, and 45-80 microg/m3 outdoors. Ozone were 1-9 microg/m3 indoors and 17-28 microg/m3 outdoors. In total, 8.9% had doctors' diagnosed asthma, 3.1% wheeze, 23.0% daytime breathlessness, 2.4% current asthma, and 2.3% asthma medication. Multiple logistic regression was applied. Observed indoor molds was associated with asthma attacks [odds ratio (OR) = 2.40: P < 0.05]. Indoor temperature was associated with daytime breathlessness (OR = 1.26 for 1 C; P < 0.001), and indoor CO2 with current asthma (OR = 1.18 for 100 ppm; P < 0.01) and asthma medication (OR = 1.15 for 100 ppm; P < 0.05). Indoor NO2 was associated with current asthma (OR = 1.51 for 10 microg/m3; P < 0.01) and asthma medication (OR = 1.45 for 10 microg/m3; P < 0.01). Outdoor NO2 was associated with current asthma (OR = 1.44 for 10 microg/m3; P < 0.05). Indoor and outdoor ozone was negatively associated with daytime breathlessness. In conclusion, asthma symptoms among pupils in Shanghai can be influenced by lack of ventilation and outdoor air pollution from traffic. Practical Implications Most urban schools in Asia are naturally ventilated buildings, often situated in areas with heavy ambient air pollution from industry or traffic. The classes are large, and window opening is the only way to remove indoor pollutants, but this results in increased exposure to outdoor air pollution. There is a clear need to improve the indoor environment in these schools. Building dampness and indoor mold growth should be avoided, and the concept of mechanical ventilation should be introduced. City planning aiming to situate new schools away from roads with heavy traffic should be considered.

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Author and article information

Journal

Journal ID (nlm-ta): Indian J Occup Environ Med

Journal ID (iso-abbrev): Indian J Occup Environ Med

Journal ID (publisher-id): IJOEM

Title: Indian Journal of Occupational and Environmental Medicine

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 0973-2284

ISSN (Electronic): 1998-3670

Publication date (Print): Sep-Dec 2018

Volume: 22

Issue: 3

Pages: 156-162

Affiliations

[1]Department of Medicine, Faculty of Medicine and Surgery, University of Malta, Msida, Malta

[1 ]Faculty of Economics, Management and Accountancy, University of Malta, Msida, Malta

Author notes

Address for correspondence: Dr. Peter Fsadni, Department of Medicine, Faculty of Medicine and Surgery, University of Malta, Msida, Malta. E-mail: peter.fsadni@ 123456um.edu.mt

Article

Publisher ID: IJOEM-22-156

DOI: 10.4103/ijoem.IJOEM_95_18

PMC ID: 6309359

SO-VID: 676bd1b8-2336-4e41-96fa-6109bbed4b28

License:

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Impact of School Air Quality on Children's Respiratory Health

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Abstract

Background:

Aims:

Settings and Design:

Materials and Methods:

Statistical Analysis Used:

Results:

Conclusions:

Related collections

Chinese Journal of School Health

Most cited references 22

Long-term exposure to close-proximity air pollution and asthma and allergies in urban children.

Poor air quality in classrooms related to asthma and rhinitis in primary schoolchildren of the French 6 Cities Study

Current asthma and respiratory symptoms among pupils in Shanghai, China: influence of building ventilation, nitrogen dioxide, ozone, and formaldehyde in classrooms.

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