A critical evaluation of acute ozone epidemiology results.

Evidence from controlled human exposure studies demonstrates transient pulmonary functional responses to ozone exposure concentrations near the U.S. primary air quality standard of 0.120 ppm. There have been several recent efforts to document low concentration ozone effects in the epidemiological setting. Quantification of ozone effects under natural conditions of exposure can provide valuable information for risk assessment. However, results of epidemiological studies on acute ozone effects have had a limited role in decisions for air quality standards. This reflects difficulties in the quantitative interpretation of results that are to some extent inherent in the epidemiological approach, such as the difficulty of assessing individual exposures, failure to account for varying activity levels, and confounding by temporal covariates, e.g., temperature and pollen. However, in spite of the limitations of individual studies, when viewed as a group the epidemiological studies are consistent among themselves and with results from chamber studies.