Outdoor, but not indoor, nitrogen dioxide exposure is associated with persistent cough during the first year of life Original Research Article

Background and aims Because their lungs and immune system are not completely developed, children are more susceptible to respiratory disease and more vulnerable to ambient pollution. We assessed the relation between prenatal and postnatal nitrogen dioxide (NO2) levels and the development of lower respiratory tract infections (LRTI), wheezing and persistent cough during the first year of life. Methods The study population consisted of 352 children from a birth cohort in Valencia, Spain. Prenatal exposure to NO2, a marker of traffic related air pollution was measured at 93 sampling sites spread over the study area during four different sampling periods of 7 days each. It was modeled for each residential address through land use regression using the empirical measurements and data from geographic information systems. Postnatal exposure was measured once inside and outside each home using passive samplers for a period of 14 days. Outcomes studied were any episode of LRTI during the childʹs first year of life diagnosed by a doctor (bronchitis, bronchiolitis or pneumonia), wheezing (defined as whistling sounds coming from the chest), and persistent cough (more than three consecutive weeks). Outcomes and potential confounders were obtained from structured questionnaires. Multiple logistic regression was used to identify associations. Results The cumulative incidence (CI) at first year of life was 30.4% for LRTI (23.0% bronchiolitis, 11.9% bronchitis and 1.4% pneumonia), 26.1% for wheezing and 6.3% for persistent cough. The adjusted odds ratio (95% confidence interval) per 10 μg/m3 increment in postnatal outdoor NO2 concentration was 1.40 (1.02–1.92) for persistent cough. We also found some pattern of association with LRTI, bronchiolitis, bronchitis, wheezing and persistent cough in different prenatal periods, although it was not statistically significant. Conclusions Our results indicate that exposure to outdoor, but not indoor, NO2 during the first year of life increases the risk of persistent cough.