This article by Boldo et al. demonstrates that in Europe, exposure to environmental tobacco smoke (ETS) caused an estimated 24% to 32% of sudden infant death syndrome (SIDS) cases and increased the number of asthma episodes by 7% to 11% in children younger than 14 years of age. The major source of exposure to ETS among children is smoking by parents and other household members. The European countries in this study included wealthy countries such as Austria, Denmark, Germany, and the United Kingdom as well as those with struggling economies such as Bulgaria, Croatia, Estonia, and Macedonia. This diversity of wealth across the 27 countries included in the study provided a range of exposures when correlated with the smoking rates. The levels of exposure to ETS for the children in the study ranged from one-fifth to one-half. Using the data from the 27 countries and applying the methods used by others to look at the association of ETS to both SIDS and asthma, the authors make a compelling case for recommending to governmental and ministerial officials that their countries follow the World Health Organization (WHO) recommendations to develop and implement enforceable smoke-free policies to avoid the ETS impact on children's health. Such a recommendation is logical, progressive, and highly protective of the most vulnerable members of the population. 1 This study also demonstrates the need for countries, as well as WHO and the European Union, to develop educational programs for parents and children to recognize the dangers of smoking, ETS, and other tobacco-related diseases.
SUMMARY
Aim:The Ostrava region suffers from high levels of air pollution during winter inversions. We investigated the association between short-term elevations of air pollutant concentrations and worsening of respiratory problems, use of asthma medication and restriction of daily activities in asthmatic patients in Ostrava.Methods: One-hundred and forty-seven child and adolescent patients (aged 6-18 years) with a confirmed diagnosis of mild to moderate persistent asthma were included in the study. Participants' parents completed diaries covering the period of November 2013 to February 2014; this analysis included 18,228 person-days. Daily smoothed maps of outdoor concentrations of particulate matter (PM 10 ), nitrogen dioxide (NO 2 ) and sulphur dioxide (SO 2 ) were constructed from routine monitoring data, and participants' daily exposures were estimated on the basis of time spent at home and at school. The associations between health outcomes and exposure to air pollutants were estimated using the multiple logistic regression method.Results: The odds ratios (OR) of the combined outcome for wheezing and/or difficulty in breathing, per 10 µg/m 3 increase in the mean 24-h exposure were 1.07 (95% confidence interval 1.04-1.11) for PM 10 , 1.30 (1.18-1.44) for NO 2 , and 1.37 (1.18-1.59) for SO 2 . Additional inhaler use (in addition to usual medication) was also more frequent at higher air pollutant concentrations; the odds ratios per 10 µg/m 3 increase in the mean 24-h exposure were 1.05 (1.02-1.07) for PM 10 , 1.19 (1.10-1.30) for NO 2 , and 1.26 (1.11-1.43) for SO 2 . Associations were less consistent for other health outcomes.Conclusions: These results suggest moderately strong associations between air pollutant concentrations and respiratory difficulties among asthmatic children and adolescents. More detailed analyses are required to confirm these preliminary findings.
The study investigated the associations between the prevalence of the childhood respiratory diseases and the long-term exposure to air pollution in the burdened area of Moravian-Silesian Region in the Czech Republic. The health data were collected during 2014 in 7,239 children 5, 9, 13 and 17 years of age. Exposure to PM and NO in the residence addresses was based on dispersion models and GIS based traffic-related indicators. PM levels were positively associated with both lifetime (OR 1.35; 95%CI 1.09-1.67) and current (OR 1.32; 95%CI 1.05-1.67) allergic rhinitis; current asthma was associated negatively. The associations between traffic indicator and respiratory health were not found. On the other hand, marked positive associations were found between the respiratory diseases and symptom severity structured into ordinal variables, and PM and NO. Modelled long-term exposure to air pollution was associated with childhood allergic rhinitis and deterioration of the respiratory symptoms.
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