Long-term exposure to ozone and children's respiratory health: Results from the RESPOZE study

Konstantina Dimakopoulou, John Douros, Evangelia Samoli, Anna Karakatsani, Sophia Rodopoulou, Despina Papakosta, Georgios Grivas, George Tsilingiridis, Ian Mudway, Nicholas Moussiopoulos, Klea Katsouyanni*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

30 Citations (Scopus)


Background: Although there is evidence on the effects of short-term ozone (O3) exposures on children's respiratory health, few studies have reported results on the effects of long-term exposures. We report the effects of long-term exposure to O3 on respiratory health outcomes in 10–11-year old children. Methods: We conducted a panel study in a sample of the general population of school children in two cities with high average O3 concentrations, Athens and Thessaloniki, Greece. All 186 participating students were followed up intensively for 5 weeks spreading across a school year. Data was collected through questionnaires, weekly personal O3 measurements, spirometry, FeNO and time-activity diaries. Long-term O3 exposure was assessed using fixed site measurements and modeling, calibrated for personal exposures. The associations between measured lung function parameters and lung function growth over the study period, as well as FeNO and the occurrence of symptoms with long-term O3 exposure were assessed through the application of multiple mixed effects 2-level regression models, adjusting for confounders and for short-term exposures. Results: A 10 μg/m3 increase in calibrated long-term O3exposure, using measurements from fixed site monitors was associated with lower FVC and FEV1 by 17 mL (95% Confidence Interval: 5–28) and 13 mL (3–21) respectively and small decreases in lung growth: 0.008% (0.002–0.014%) for FVC and 0.006% (0.000–0.012%) in FEV1 over the study period. No association was observed with PEF, FeNO or the occurrence of symptoms. A similar pattern was observed when the exposure estimates from the dispersion models were employed. Conclusions: Our study provides evidence that long-term O3 exposure is associated with reduced lung volumes and growth.

Original languageEnglish
Article number109002
JournalEnvironmental Research
Publication statusPublished - 1 Mar 2020


  • Long-term exposure
  • Lung function
  • Ozone
  • Panel study
  • School-age children


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