Air pollution and respiratory symptoms: Results from three panel studies in Bangkok, Thailand

Several studies in North American cities have reported associations between air pollution and respiratory symptoms. Replicating these studies in cities with very different population and weather characteristics is a useful way of addressing uncertainties and strengthening inferences of causality. To this end we examined the response of three different panels to particulate matter (PM) air pollution in Bangkok, Thailand, a tropical city characterized by a very warm and humid climate. Panels of schoolchildren, nurses, and adults were asked to report daily upper and lower respiratory symptoms for 3 months. Concentrations of daily PM₁₀ (PM with a mass median aerodynamic diameter less than 10 μm) and PM_2.5 (airborne particles with aerodynamic diameters less than 2.5 μm) were collected at two sites. Generally, associations were found between these pollution metrics and the daily occurrence of both upper and lower respiratory symptoms in each of the panels. For example, an interquartile increase of 45 μg/m³ in PM₁₀ was associated with about a 50% increase in lower respiratory symptoms in the panel of highly exposed adults, about 30% in the children, and about 15% in the nurses. These estimates were not appreciably altered by changes in the specification of weather variables, stratification by temperature, or inclusion of individual characteristics in the models; however, time trends in the data cause some uncertainty about the magnitude of the effect of PM on respiratory symptoms. These pollutants were also associated with the first day of a symptom episode in both adult panels but not in children. The estimated odds ratios are generally consistent with and slightly higher than the findings of previous studies conducted in the United States.