Review Article

Association between Traffic Related Air Pollution and the Development of Asthma Phenotypes in Children: A Systematic Review

Table 1

Characteristics of included studies.

Study Reference and settingStudy designAge groupParticipants includedExposure assessmentTraffic related pollutantsTraffic related pollutants measuredAsthma assessmentTransient asthma/wheezing definitionPersistent asthma/wheezing definitionLate-onset asthma/wheezing definitionAdjustment variablesCASP comments

(Brauer et al., 2006), Utrecht, Netherlands [19]Birth cohort (PIAMA)Birth – 4 years4146LUR modelPM2.5, NO2PM2.5 mean: 16.9, range:   µg/m3;
NO2 mean: 25.4, range:   µg/m3
Parental reporting of asthma/wheezeReport of wheezing at age of 3 but not at age of 4Report of wheezing at age of 3 as well as at age of 4No report of wheezing at age of 3 but wheezing reported at age of 4Sex, study arm, allergic mother/father, mother/father’s education, maternal smoking during pregnancy, breastfeeding at 3 months, gas stove, unvented gas water heater, siblings at birth, smoking at home, dampness in living room/child’s bedroom, pets, daycare attendance, Dutch nationality, moving houses before age of 8Pollutant levels only measured for four 2-week periods in a single year,
risk of recall bias, no adjustment for familial history of asthma, race, or socioeconomic status (outside of education)

(Gehring et al., 2010), Utrecht, Netherlands [14]Birth cohort (PIAMA)Birth – 8 years3863LUR modelPM2.5, NO2PM2.5 mean: 16.9, range: [13.5, 25.2]  µg/m3;
NO2 mean: 25.4, range:   µg/m3
Parental report of wheezingReport of wheezing before age of 3 but no wheezing after age of 6Report of wheezing before age of 3 as well as after age of 6No report of wheezing before age of 3 but wheezing at age of 6 or laterSex, study arm, allergic mother/father, mother/father’s education, maternal smoking during pregnancy, breastfeeding at 3 months, gas stove, unvented gas water heater, siblings at birth, smoking at home, dampness in living room/child’s bedroom, pets, daycare attendance, Dutch nationality, moving houses before age of 8Pollutant levels only measured for four 2-week periods in a single year,
risk of recall bias, no adjustment for familial history of asthma, race, or socioeconomic status (outside of education)

(Nordling et al., 2007), Stockholm, Sweden [20]Birth cohort (BAMSE)Birth – 4 years3515Dispersion modelPM10, PM10 mean: 3.9, percentile: [0.94, 6.8] µg/m3;
mean: 23.1, percentile:   µg/m3
Parental report of wheezingAt least 3 episodes
of wheezing before age of 2 but no episodes between ages of 3 and 4
At least 1 wheezing episode before age of 2 and at least 1 wheezing episode between ages of 3 and 4No
episode of wheezing before age of 2 but at least 1 episode of wheezing between ages of 3 and 4
Municipality, socioeconomic status, heredity, mother’s smoking during pregnancy and infancy, year that house was built, damp
or mold in the home at birth, and sex of the child
Risk of recall bias, no adjustment for race, endpoint is early for persistent asthma diagnosis

(Oftedal et al., 2009), Oslo, Norway [21]Birth cohort (Oslo)Birth – 10 years2871Dispersion model (EPISODE)NO2NO2 range: (1.4, 65.1), mean: 25.3 µg/m3;Parental reporting of doctor-diagnosed asthma/wheezeNoneNoneOnset of doctor-diagnosed asthma after age of 4 yearsSex, parental atopy, maternal smoking in pregnancy, paternal education, and maternal marital status at the child’s birth. Parental atopy was defined as a history of maternal or paternal asthma, hay fever, or eczemaRisk of recall bias, no adjustment for race nor socioeconomic status (except education and marital status)

(Pennington et al., 2018), Atlanta, Georgia, USA [22]Birth cohort (KAPPA)Birth – 6 years24 608Dispersion model (RLINE)CO, PM2.5, CO median: 0.59 ppm; median: 55.5 ppb PM2.5 range: (0.06, 13.8), median 1.55 µg/m3At least one doctor diagnosis of asthma
and one asthma-related medication dispensing after the first year of life from medical records
NoneEvidence of incident asthma
who also had evidence of asthma in the past year at each follow-up age up to age of 5 years
NoneSex, race, ethnicity, maternal asthma,
maternal age, parental education, maternal marital status, neighborhood socioeconomic status (SES), birth year, and
city region
Results presented as absolute risk difference, difficult to interpret

(Rancière et al., 2017), Paris, France [23]Birth cohort (PARIS)Birth – 4 years3840Dispersion model (Extra Index)NO2 range: (39.0, 257.0), median: 75 µg/m3Parental reporting of doctor-diagnosed asthma or wheezing in the past 12 months at ages of 1, 2, 3, and 4Wheezing occurring between 0 and 2 years of age and not till age of 4Wheezing occurring between 0 and 2 years of age and persisting till age of 4Wheezing occurring between 2 and 4 years of ageSex, birth weight, family socioeconomic status, maternal education level, maternal history of asthma, allergic rhinitis, or eczema, paternal history of asthma, allergic rhinitis, or eczema, maternal smoking during pregnancy, exposure to environmental tobacco smoke at home during the first year, exclusive breastfeeding during the first 3 months, type of child care during the first 6 months, stressful family events during the first 2 years, body mass index ≥ 85th percentile for age and sex at 2–3 years, use of gas for cooking or
heating in the home, and visible mold in the home
Potential for recall bias, no adjustment for race, endpoint is early for persistent wheezing diagnosis

(Sbihi et al., 2017), Vancouver, British Columbia, Canada [4]Birth cohortBirth – 10 years68 195LUR modelNO2, PM2.5NO2 range: (15.0, 53.7), median: 33.3 µg/m3;
PM2.5 range: (3.2, 7.6), median: 5.4 µg/m3
At least two primary
care physician diagnoses within a 12-month period or a minimum of one hospital admission was identified as
asthma cases each year
Asthma definition is met by age of 1 with asthma prevalence peaking among the group by age of 2 and no asthma activity after age of 6Asthma develops by age of 3 with asthma prevalence peaking among the group by age of 4 that is sustained until the end
of follow-up
Asthma develops by age of 3 with asthma prevalence peaking among the group by age of 6 and is sustained until the end
of follow-up
Sex, parity, breastfeeding initiation, birth weight, delivery mode, maternal
smoking and educational attainment, and household income
Did not adjust for familial history of asthma, race, ethnicity
Odds ratios reported only to 1 decimal place, only study to find an association between TRAP and late-onset asthma

No result on the association between pollutant exposure and late-onset asthma phenotype was reported.
Asthma phenotypes were defined based on group based trajectory modelling.