Air pollution and acute respiratory illness in five German communities.

To assess the impact of short-term exposure to air pollution on respiratory illness in children we recruited pediatricians and hospitals in five German cities to report daily counts of children's visits for croup symptoms and obstructive bronchitis. Data were collected for at least 2 years in each location. These symptoms are predominantly found in very young children, with the croup reporting peaking at 2 years of age and obstructive bronchitis at 1 year. Attacks of croup and obstructive bronchitis were relatively rare events: the mean number of cases of croup per day in each city ranged from 0.5 to 3, and obstructive bronchitis was even less frequent. A total of 6330 cases of croup and 4755 cases of obstructive bronchitis were observed during the study. The distributions of these events were quite skewed and were modeled as a Poisson process. To focus the analysis on short-term correlations and avoid seasonal confounding, biannual, annual (seasonal), and six shorter term cycles were controlled for in the regression models. After controlling for short-term weather factors, total suspended particulate matter (TSP) and nitrogen dioxide (NO2) were associated with croup cases. An increase in TSP levels from 10 micrograms/m3 to 70 micrograms/m3 was associated with a 27% increase in cases of croup; the same increase in NO2 levels resulted in a 28% increase in cases. No pollutant was associated with daily cases of obstructive bronchitis.