J Korean Med Sci.  2011 Feb;26(2):166-173. 10.3346/jkms.2011.26.2.166.

Respiratory Health among Korean Pupils in Relation to Home, School and Outdoor Environment

• Kim JL
• Elfman L
• Wieslander G
• Ferm M
• Toren K
• Norback D

• KMID: 1782102
• DOI: http://doi.org/10.3346/jkms.2011.26.2.166

Abstract

There are few studies about school-environment in relation to pupils' respiratory health, and Korean school-environment has not been characterized. All pupils in 4th grade in 12 selected schools in three urban cities in Korea received a questionnaire (n = 2,453), 96% participated. Gaseous pollutants and ultrafine particles (UFPs) were measured indoors (n = 34) and outdoors (n = 12) during winter, 2004. Indoor dampness at home was investigated by the questionnaire. To evaluate associations between respiratory health and environment, multiple logistic- and multi-level regression models were applied adjusting for potential confounders. The mean age of pupils was 10 yr and 49% were boys. No school had mechanical ventilation and CO2-levels exceeded 1,000 ppm in all except one of the classrooms. The indoor mean concentrations of SO2, NO2, O3 and formaldehyde were 0.6 microg/m3, 19 microg/m3, 8 microg/m3 and 28 microg/m3, respectively. The average level of UFPs was 18,230 pt/cm3 in the classrooms and 16,480 pt/cm3 outdoors. There were positive associations between wheeze and outdoor NO2, and between current asthma and outdoor UFPs. With dampness at home, pupils had more wheeze. In conclusion, outdoor UFPs and even low levels of NO2 may adversely contribute to respiratory health in children. High CO2-levels in classrooms and indoor dampness/mold at home should be reduced.

Keyword

Asthma; Indoor Dampness; Mold Nitrogen Dioxide; Ultrafine Particles

MeSH Terms

Air Pollutants
*Air Pollution
*Asthma
Carbon Dioxide
Child
Cross-Sectional Studies
*Environment
Humans
Humidity
Male
Nitrates
Questionnaires
Republic of Korea
Respiratory Sounds
Schools
Sulfur Dioxide

Reference

1. Nordling E, Berglind N, Melén E, Emenius G, Hallberg J, Nyberg F, Pershagen G, Svartengren M, Wickman M, Bellander T. Traffic-related air pollution and childhood respiratory symptoms, function and allergies. Epidemiology. 2008. 19:401–408.

2. Yorifuji T, Kashima S, Tsuda T, Takao S, Suzuki E, Doi H, Sugiyama M, Ishikawa-Takata K, Ohta T. Long-term exposure to traffic-related air pollution and mortality in Shizuoka, Japan. Occup Environ Med. 2010. 67:111–117.

3. Andersen ZJ, Loft S, Ketzel M, Stage M, Scheike T, Hermansen MN, Bisgaard H. Ambient air pollution triggers wheezing symptoms in infants. Thorax. 2008. 63:710–716.

4. Penn A, Murphy G, Barker S, Henk W, Penn L. Combustion-derived ultrafine particles transport organic toxicants to target respiratory cells. Environ Health Perspect. 2005. 113:956–963.

5. Weichenthal S, Dufresne A, Infante-Rivard C. Indoor ultrafine particles and childhood asthma: exploring a potential public health concern. Indoor Air. 2007. 17:81–91.

6. Bornehag CG, Sundell J, Hagerhed-Engman L, Sigsggard T, Janson S, Aberg N. DBH Study Group. 'Dampness' at home and its association with airway, nose, and skin symptoms among 10,851 preschool children in Sweden: a cross-sectional study. Indoor Air. 2005. 15:Suppl 10. 48–55.

7. Venn AJ, Cooper M, Antoniak M, Laughlin C, Britton J, Lewis SA. Effects of volatile organic compounds, damp, and other environmental exposures in the home on wheezing illness in children. Thorax. 2003. 58:955–960.

8. Belanger K, Gent JF, Triche EW, Bracken MB, Leaderer BP. Association of indoor nitrogen dioxide exposure with respiratory symptoms in children with asthma. Am J Respir Crit Care Med. 2006. 173:297–303.

9. Bae H, Yang W, Chung M. Indoor and outdoor concentrations of RSP, NO₂ and selected volatile organic compounds at 32 shoe stalls located near busy roadways in Seoul, Korea. Sci Total Environ. 2004. 323:99–105.

10. Hong YC, Leem JH, Lee KH, Park DH, Jang JY, Kim ST, Ha EH. Exposure to air pollution and pulmonary function in university students. Int Arch Occup Environ Health. 2005. 78:132–138.

11. Lee JT, Kim H, Song H, Hong YC, Cho YS, Shin SY, Hyun YJ, Kim YS. Air pollution and asthma among children in Seoul, Korea. Epidemiology. 2002. 13:481–484.

12. Kim JL, Elfman L, Mi Y, Johansson M, Smedje G, Norbäck D. Current asthma and respiratory symptoms among pupils in relation to dietary factors and allergens in the school environment. Indoor Air. 2005. 15:170–182.

13. Skov P, Valbjørn O, Pedersen BV. The Danish Indoor Climate Study Group. Influence of indoor climate on the sick building syndrome in an office environment. Scand J Work Environ Health. 1990. 16:363–371.

14. Air quality guidelines global update. Report on a working group metting, Bonn, Germany, 18-20 October, 2005. World Health Organization. accessed on 21 Dec 2009. Available at http://www.euro.who.int/__data/assets/pdf_file/0005/78638/E90038.pdf.

15. Air quality guidelines for Europe: Second edition Cophenhagen, 2000. WHO regional office for Europe. accessed on 21 Dec 2009. Available at http://www.euro.who.int/__data/assets/pdf_file/0005/74732/E71922.pdf.

16. Braun-Fahrländer C, Wüthrich B, Gassner M, Grize L, Sennhauser FH, Varonier HS, Vuille JC. Validation of a rhinitis symptom questionnaire (ISAAC core questions) in a population of Swiss school children visiting the school health services. SCARPOL-team. Swiss Study on Childhood Allergy and Respiratory Symptom with respect to Air Pollution and Climate. International Study of Asthma and Allergies in Childhood. Pediatr Allergy Immunol. 1997. 8:75–82.

17. Kim YY, Cho SH, Kim WK, Park JK, Song SH, Kim YK, Jee YK, Ha MN, Ahn YO, Lee SI, Min KU. Prevalence of childhood asthma based on questionnaires and methacholine bronchial provocation test in Korea. Clin Exp Allergy. 1997. 27:761–768.

18. Lee SI, Shin MH, Lee HB, Lee JS, Son BK, Koh YY, Kim KE, Ahn YO. Prevalences of symptoms of asthma and other allergic diseases in Korean children: a nationwide questionnaire survey. J Korean Med Sci. 2001. 16:155–164.

19. Hong SJ, Lee MS, Sohn MH, Shim JY, Han YS, Park KS, Ahn YM, Son BK, Lee HB. Korean ISAAC Study Group. Self-reported prevalence and risk factors of asthma among Korean adolescents: 5-year follow-up study, 1995-2000. Clin Exp Allergy. 2004. 34:1556–1562.

20. Lee JG, Moon HJ, Kim KS, Yoon JH, Kim SS, Park IY. Epidemiological study for allergic disease of school aged children and adolescence in rural area of Korea. Korean J Otolaryngol-Head Neck Surg. 1998. 41:1156–1163.

21. Hagmolen of Ten Have W, van den Berg NJ, van der Palen J, van Aalderen WM, Bindels PJ. Residential exposure to mould and dampness is associated with adverse respiratory health. Clin Exp Allergy. 2007. 37:1827–1832.

22. Ree HI, Jeon SH, Lee IY, Hong CS, Lee DK. Fauna and geographical distribution of house dust mites in Korea. Korean J Parasitol. 1997. 35:9–17.

23. Kim JL, Elfman L, Norbäck D. Respiratory symptoms, asthma and allergen levels in schools--comparison between Korea and Sweden. Indoor Air. 2007. 17:122–129.

24. ASHRAE. Ventilation for acceptable indoor air quality. ASHRAE-Standard 62-1989. 1989. Atlanta: American Society of Heating, Refrigerating and Air-Conditioning Engineers, INC.

25. Sohn J, Yang W, Kim J, Son B, Park J. Indoor air quality investigation according to age of the school buildings in Korea. J Environ Manage. 2009. 90:348–354.

26. Yang W, Lee K, Chung M. Characterization of indoor air quality using multiple measurements of nitrogen dioxide. Indoor Air. 2004. 14:105–111.

27. Diapouli E, Chaloulakou A, Mihalopoulos N, Spyrellis N. Indoor and outdoor PM mass and number concentrations at schools in the Athens area. Environ Monit Assess. 2008. 136:13–20.

28. Weichenthal S, Dufresne A, Infante-Rivard C, Joseph L. Characterizing and predicting ultrafine particle counts in Canadian classrooms during the winter months: model development and evaluation. Environ Res. 2008. 106:349–360.

29. Mi YH, Norbäck D, Tao J, Mi YL, Ferm M. Current asthma and respiratory symptoms among pupils in Shanghai, China: influence of building ventilation, nitrogen dioxide, ozone, and formaldehyde in classrooms. Indoor Air. 2006. 16:454–464.

30. Dick CA, Brown DM, Donaldson K, Stone V. The role of free radicals in the toxic and inflammatory effects of four different ultrafine particle types. Inhal Toxicol. 2003. 15:39–52.