Open Access Highly Accessed Open Badges Research

Particulate matter air pollution and respiratory symptoms in individuals having either asthma or chronic obstructive pulmonary disease: a European multicentre panel study

Anna Karakatsani1*, Antonis Analitis2, Dimitra Perifanou2, Jon G Ayres3, Roy M Harrison45, Anastasia Kotronarou6, Ilias G Kavouras6, Juha Pekkanen78, Kaarle Hämeri9, Gerard PA Kos10, Jeroen J de Hartog11, Gerard Hoek11 and Klea Katsouyanni2

Author Affiliations

1 2nd Department of Respiratory Medicine, “ATTIKON” University Hospital, Medical School, National and Kapodistrian University of Athens, 124 62, Haidari, Greece

2 Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27, Goudi, Athens, Greece

3 Institute of Occupational and Environmental Medicine, University of Birmingham, Birmingham, United Kingdom

4 Division of Environmental Health and Risk Management, School of Geography, Earth and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, B152TT, United Kingdom

5 Department of Environmental Sciences / Center of Excellence in Environmental Studies, King Abdulaziz University, PO Box 80203, Jeddah, 21589, Saudi Arabia

6 National Observatory of Athens, Institute for Environmental Research and Sustainable Development, Athens, Greece

7 Department of Environmental Health, National Institute for Health and Welfare, Kuopio, Finland

8 Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland

9 Department of Physics, University of Helsinki, Helsinki, Finland

10 Energy research Center of the Netherlands, Environment and Energy Engineering, Environmental Assessment, Petten, The Netherlands

11 University of Utrecht, Institute for Risk Assessment Sciences, Utrecht, The Netherlands

For all author emails, please log on.

Environmental Health 2012, 11:75  doi:10.1186/1476-069X-11-75

Published: 5 October 2012



Particulate matter air pollution has been associated with adverse health effects. The fraction of ambient particles that are mainly responsible for the observed health effects is still a matter of controversy. Better characterization of the health relevant particle fraction will have major implications for air quality policy since it will determine which sources should be controlled.

The RUPIOH study, an EU-funded multicentre study, was designed to examine the distribution of various ambient particle metrics in four European cities (Amsterdam, Athens, Birmingham, Helsinki) and assess their health effects in participants with asthma or COPD, based on a detailed exposure assessment. In this paper the association of central site measurements with respiratory symptoms and restriction of activities is examined.


At each centre a panel of participants with either asthma or COPD recorded respiratory symptoms and restriction of activities in a diary for six months. Exposure assessment included simultaneous measurements of coarse, fine and ultrafine particles at a central site. Data on gaseous pollutants were also collected. The associations of the 24-hour average concentrations of air pollution indices with the health outcomes were assessed in a hierarchical modelling approach. A city specific analysis controlling for potential confounders was followed by a meta-analysis to provide overall effect estimates.


A 10 μg/m3 increase in previous day coarse particles concentrations was positively associated with most symptoms (an increase of 0.6 to 0.7% in average) and limitation in walking (OR= 1.076, 95% CI: 1.026-1.128). Same day, previous day and previous two days ozone concentrations were positively associated with cough (OR= 1.061, 95% CI: 1.013-1.111; OR= 1.049, 95% CI: 1.016-1.083 and OR= 1.059, 95% CI: 1.027-1.091, respectively). No consistent associations were observed between fine particle concentrations, nitrogen dioxide and respiratory health effects. As for particle number concentrations negative association (mostly non-significant at the nominal level) was observed with most symptoms whilst the positive association with limitation of activities did not reach the nominal level of significance.


The observed associations with coarse particles are in agreement with the findings of toxicological studies. Together they suggest it is prudent to regulate also coarse particles in addition to fine particles.

Air pollution; Asthma; Chronic obstructive pulmonary disease; Coarse particles; Particle number concentration; Respiratory health