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Studies on traffic exposure, (including detailed studies on occupational exposure to increased
vehicular emissions (Raaschou-Nielsen, Nielsen et al. 1995; Zagury,6 Moullec et al. 2000;
Roegner, Sieber et al. 2002; Seshagiri 2003; Lai, Liou et al. 2005) and occupational NO
exposure (Azan, Williams et al. 1996; Markhorst, I-eenhoven et al. 1996; Olin, Ljungkvist et
al. 1999; Phillips, Hall et al. 1999 Qureshi, Shah et al. 20O3; Maniscalco, Grieco et al.
2004)), have also demonstrated that there is a consistent effect of long term exposure to car
traffic on non-specific respiratory symptoms (Abbey, Hwang et al. 1995) and lung function
(Ackermann-Liebrich, kuenberger et al. 1997). Proximity to traffic exposure was a risk
factor for wheezing, asthma severity and prevalence (Nitta, Sato et al. 1993; Oosterlee,
Drijver et al. 1996, Brunekreef, 1997 #640).In three Japanese cross sectional questionnaire
studies in five thousand women participants, the estimated odds ratio for chronic cough,
chronic sputum production, chronic wheeze and chest infections with sputum were increased
the closer the subjects lived to roadways with heavy traffic (Nitta, Sato et al. 1993). Air
pollution appears more likely to exacerbate existing asthma rather than generate new cases,
although it is associated with reduced lung function in healthy children (Barnes 1994; Segala
1999). There are fewer studies that have looked at the effects of air pollution on upper airway
disease rates, but general practitioner consultations due to upper airway symptoms increase on
days of higher concentrations of particulate matter and SOz (Gordian, Ozkaynak et al. 1996;
Hernandez-Garduno, Perez-Neria et al. 1997;Hajat, Anderson et al.2oo2).
Only a few authors have looked specifically at the effects of air pollution on children, where
both outdoor air pollution and indoor air quality have been implicated as causal factors for
respiratory diseases and respiratory symptoms (Nicolai 1999). An increase in mortality in
children during severe episodes of air pollution has been shown and this includes an increase
in the general rate of mortality, an increase in respiratory mortality and an increase in peri-
neonatal mortality (Bates 1995; Anderson, Ponce de kon et al. 1996). As well as mortality,
an increase in respiratory morbidity has been shown. The respiratory illnesses sensitive to
increased pollutants in children include acute bronchitis, cough, asthma and pneumonia.
Similarly to adults, this is most often attributable to an increase in particulate matter (Aunan
1996). In the 'Six Cities Study of Air Pollution and Health' reported rates of chronic cough,
bronchitis and chest illness were positively associated with all measures of particulate
pollution and positively, though less strongly, associated with SOz and NOz @ockery,
Speizer et al. 1989). Particulate matter in air pollution has been shown to triple the prevalence
of chronic cough, nocturnal cough and bronchitis in a cross sectional study of over 4,000
Swiss children aged six to 15 years from ten different communities with the highest pMl0
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