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Programming of respiratory health in childhood: influence of outdoor air pollution

Wright, Rosalind J.a,b; Brunst, Kelly J.a

Current Opinion in Pediatrics: April 2013 - Volume 25 - Issue 2 - p 232–239
doi: 10.1097/MOP.0b013e32835e78cc

Purpose of review This overview highlights recent experimental and epidemiological evidence for the programming effects of outdoor air pollution exposures during early development on lung function and chronic respiratory disorders, such as asthma and related allergic disorders.

Recent findings Air pollutants may impact anatomy and/or physiological functioning of the lung and interrelated systems. Programming effects may result from pollutant-induced shifts in a number of molecular, cellular, and physiological states and their interacting systems. Specific key regulatory systems susceptible to programming may influence lung development and vulnerability to respiratory diseases, including both central and peripheral components of neuroendocrine pathways and autonomic nervous system (ANS) functioning which, in turn, influence the immune system. Starting in utero, environmental factors, including air pollutants, may permanently organize these systems toward trajectories of enhanced pediatric (e.g., asthma, allergy) as well as adult disease risk (e.g., chronic obstructive pulmonary disease). Evidence supports a central role of oxidative stress in the toxic effects of air pollution. Additional research suggests xenobiotic metabolism and subcellular components, such as mitochondria are targets of ambient air pollution and play a role in asthma and allergy programming. Mechanisms operating at the level of the placenta are being elucidated. Epigenetic mechanisms may be at the roots of adaptive developmental programming.

Summary Optimal coordinated functioning of many complex processes and their networks of interaction are necessary for normal lung development and the maintenance of respiratory health. Outdoor air pollution may play an important role in early programming of respiratory health and is potentially amenable to intervention.

aDepartment of Pediatrics, Division of Pulmonary Medicine

bDepartment of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA

Correspondence to Rosalind J. Wright, MD, MPH, Department of Pediatrics, Division of Pulmonary Medicine, New York, USA. Tel: +1 212 241 5287; fax: +1 212 289 8569; e-mail:

© 2013 Lippincott Williams & Wilkins, Inc.