Intraday effects of outdoor air pollution on acute upper and lower respiratory infections in Australian children

Children’s respiratory health are particularly vulnerable to outdoor air pollution, but evidence is lacking on the very acute effects of air pollution on the risk of acute upper respiratory infections (AURI) and acute lower respiratory infections (ALRI) in children. This study aimed to evaluate the risk of cause-specific AURI and ALRI, in children within 24 h of exposure to air pollution. We obtained data on emergency cases, including 11,091 AURI cases (acute pharyngitis, acute tonsillitis, acute obstructive laryngitis and epiglottitis, and unspecified acute upper respiratory infections) and 11,401 ALRI cases (pneumonia, acute bronchitis, acute bronchiolitis, unspecified acute lower respiratory infection) in Brisbane, Australia, 2013–2015. A time-stratified case-crossover analysis was used to examine the hourly association of AURI and ALRI with high concentration (95th percentile) of four air pollutants (particulate matters with aerodynamic diameter <10 μm (PM₁₀) and <2.5 μm (PM₂.₅), ozone (O₃), nitrogen dioxide (NO₂)). We observed increased risk of acute tonsillitis associated with PM₂.₅ within 13–24 h (odds ratio (OR), 1.45; 95% confidence interval [CI], 1.02–2.06) and increased risk of unspecified acute upper respiratory infections related to O₃ within 2–6 h (OR, 1.38, 95%CI, 1.12–1.70), NO₂ within 1 h (OR, 1.19; 95%CI, 1.01–1.40), and PM₂.₅ within 7–12 h (OR, 1.21; 95%CI, 1.02–1.43). Cold season and nigh-time air pollution has greater effects on AURI, whereas greater risk of ALRI was seen in warm season and daytime. Our findings suggest exposures to particulate and gaseous air pollution may transiently increase risk of AURI and ALRI in children within 24 h. Prevention measures aimed at protecting children’s respiratory health should consider the very acute effects of air pollution.