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Air pollution and exhaled nitric oxide in Dutch schoolchildren
  1. Haitske Graveland1,
  2. Sofie A H Van Roosbroeck2,
  3. Wilhelmina M Rensen3,
  4. Bert Brunekreef1,4,
  5. Ulrike Gehring1
  1. 1Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
  2. 2Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium
  3. 3CNR - Institute of Molecular Biology and Pathology, c/o Department of Genetics and Molecular Biology, Sapienza University, Rome, Italy
  4. 4Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
  1. Correspondence to Ulrike Gehring, Institute for Risk Assessment Sciences, Utrecht University, Jenalaan 18 d, 3584 CK Utrecht, The Netherlands; u.gehring{at}


Background Short-term changes in air pollution exposure in children may be associated with transient increases in exhaled nitric oxide (NO), a marker of airway inflammation. Also, children living in areas with high air pollution levels and/or high traffic densities appear to have chronically increased levels of exhaled NO. No studies have simultaneously addressed the long-term and short-term associations between traffic-related air pollution and exhaled NO.

Objectives To investigate associations between exhaled NO in school children and both short-term changes in outdoor PM10 and long-term traffic exposures.

Methods Offline exhaled NO measurements were conducted in 812 children from nine Dutch schools within 400 m of motorways. Daily levels of particulate matter with a 50% cut-off aerodynamic diameter of 10 μm (PM10) were obtained from background monitoring stations. Long-term exposure to traffic-related air pollution was assessed using specific traffic-related characteristics such as total, car and truck motorway traffic and the distances of the children's homes and schools from the motorway.

Results A positive association was found between ambient PM10 concentrations on the day of exhaled NO measurement and exhaled NO (adjusted geometric means ratio (95% CI) 2.24 (1.37 to 3.65)) over the range of daily PM10 concentrations of 44 μg/m3), which was largely attributable to a pollution peak associated with high particulate matter emissions from traditional Easter fires. There were suggestive associations between exhaled NO and traffic counts only in children with asthma, which were not statistically significance.

Conclusions Short-term changes in ambient PM10 largely attributable to biomass burning are associated with increased levels of exhaled NO.

  • Air pollution
  • children
  • exhaled nitric oxide
  • particulate matter
  • traffic
  • epidemiology

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  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the medical ethics committee of Utrecht University.

  • Provenance and peer review Not commissioned; externally peer reviewed.