Association of Changes in Air Quality With Bronchitic Symptoms in Children in California, 1993-2012

JAMA. 2016 Apr 12;315(14):1491-501. doi: 10.1001/jama.2016.3444.


Importance: Childhood bronchitic symptoms are significant public and clinical health problems that produce a substantial burden of disease. Ambient air pollutants are important determinants of bronchitis occurrence.

Objective: To determine whether improvements in ambient air quality in Southern California were associated with reductions in bronchitic symptoms in children.

Design, setting, and participants: A longitudinal study involving 4602 children (age range, 5-18 years) from 3 cohorts was conducted during the 1993-2001, 1996-2004, and 2003-2012 years in 8 Southern California communities. A multilevel logistic model was used to estimate the association of changes in pollution levels with bronchitic symptoms.

Exposures: Average concentrations of nitrogen dioxide, ozone, particulate matter with an aerodynamic diameter of less than 10 µm (PM10) and less than 2.5 µm (PM2.5).

Main outcomes and measures: Annual age-specific prevalence of bronchitic symptoms during the previous 12 months based on the parent's or child's report of a daily cough for 3 months in a row, congestion or phlegm other than when accompanied by a cold, or bronchitis.

Results: The 3 cohorts included a total of 4602 children (mean age at baseline, 8.0 years; 2268 girls [49.3%]; 2081 Hispanic white [45.2%]) who had data from 2 or more annual questionnaires. Among these children, 892 (19.4%) had asthma at age 10 years. For nitrogen dioxide, the odds ratio (OR) for bronchitic symptoms among children with asthma at age 10 years was 0.79 (95% CI, 0.67-0.94) for a median reduction of 4.9 ppb, with absolute decrease in prevalence of 10.1%. For ozone, the OR was 0.66 (95% CI, 0.50-0.86) for a median reduction of 3.6 ppb, with an absolute decrease in prevalence of 16.3%. For PM10, the OR was 0.61 (95% CI, 0.48-0.78) for a median reduction of 5.8 µg/m3, with an absolute decrease in prevalence of 18.7%. For PM2.5, the OR was 0.68 (95% CI, 0.53-0.86) for a median reduction of 6.8 µg/m3, with absolute decrease in prevalence of 15.4%. Among children without asthma (n = 3710), the ORs were 0.84 (95% CI, 0.76-0.92) for nitrogen dioxide; 0.85 (95% CI, 0.74-0.97) for ozone, 0.80 (95% CI, 0.70-0.92) for PM10, and 0.79 (95% CI, 0.69-0.91) for PM2.5; with absolute decrease in prevalence of 1.8% for nitrogen dioxide, 1.7% for ozone, 2.2% for PM10, and 2.3% for PM2.5. The associations were similar or slightly stronger at age 15 years.

Conclusions and relevance: Decreases in ambient pollution levels were associated with statistically significant decreases in bronchitic symptoms in children. Although the study design does not establish causality, the findings support potential benefit of air pollution reduction on asthma control.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Age Factors
  • Air Pollutants / analysis*
  • Air Pollution / analysis*
  • Air Pollution / prevention & control
  • Asthma / epidemiology*
  • Bronchitis / epidemiology*
  • California / epidemiology
  • Child
  • Child, Preschool
  • Cough / epidemiology
  • Environmental Monitoring
  • Female
  • Humans
  • Logistic Models
  • Longitudinal Studies
  • Male
  • Nitrogen Dioxide / analysis
  • Odds Ratio
  • Ozone / analysis
  • Particulate Matter / analysis
  • Particulate Matter / chemistry
  • Prevalence
  • Time Factors


  • Air Pollutants
  • Particulate Matter
  • Ozone
  • Nitrogen Dioxide