Agrawal Twinkle, Phuleria Harish C, Mohan Anant, D'Souza George, Thimmulappa Rajesh, Jayaraj Biligere Siddaiah, Mani Minu Rose, Patil Swapnali, Samdarshi Priya, Nori-Sarma Amruta, Wellenius Gregory, Mahesh Padukudru Anand
Department of Community Health, St John's National Academy of Health Sciences, Bengaluru, Karnataka, India.
Environmental Science and Engineering Department, Indian Institute of Technology Bombay, Mumbai, Maharashtra, India.
BMJ Open. 2025 Aug 12;15(8):e106329. doi: 10.1136/bmjopen-2025-106329.
Air pollution is a significant global health concern, with studies from the USA and Europe linking long-term exposure to respiratory issues and poor school attendance in children. While Indian cities experience much higher pollution levels, the impact on lung development in Indian children remains unclear. This study aims to assess the burden of impaired lung function in Indian children and identify key factors contributing to pollution-induced lung injury.
This longitudinal, prospective cohort study is conducted in four cities categorised by particulate matter 2.5 (PM) levels: 'very high' (Delhi), 'high' (Mumbai, Bangalore) and 'moderate' (Mysore). A total of 4000 participants (1000 from each city) will be included in the study. Participants will complete a structured questionnaire covering sociodemographics, asthma and allergy history (International Study of Asthma and Allergies in Childhood core questionnaire), dietary intake (24-hour recall and Food Frequency Questionnaire), Physical Activity-C Questionnaire and air pollution exposure. Spirometry and Forced Oscillation Technique will be used to assess lung function. Blood samples will be collected for identification of biomarkers to predict lung impairment. After quality checks, data will be compiled, summarising pulmonary function parameters alongside covariates and confounders. Analysis of Variance (ANOVA) will assess between-city and within-city differences in lung function.We anticipate a higher prevalence of reduced lung function in children residing in cities with very high and high PM levels compared with the moderately polluted city. Findings from this study could establish normal age-appropriate lung function reference values for Indian urban children, aiding in clinical diagnosis.If a reliable biomarker for identifying children at risk of lung impairment is available, it could serve as an early predictor of poor lung health in asymptomatic children.
The approval from individual site institutional review board (IRB) is obtained prior to initiation of the study from institutional ethics committee, St. John's Medical College and Hospital, Bangalore; institutional ethics committee, JSS Medical College, Mysore; institute ethics committee, Indian Institute of Technology Bombay and institute ethics committee, All India Institute of Medical Sciences. Findings from this study will be disseminated through conference presentations, peer-reviewed publications and establishment of normal age-appropriate lung function reference values for children living in urban India.
空气污染是一个重大的全球健康问题，美国和欧洲的研究表明，长期暴露在污染环境中会导致儿童出现呼吸问题和出勤率低的情况。虽然印度城市的污染水平要高得多，但空气污染对印度儿童肺部发育的影响仍不明确。本研究旨在评估印度儿童肺功能受损的负担，并确定导致污染性肺损伤的关键因素。
本纵向前瞻性队列研究在四个根据细颗粒物2.5（PM）水平分类的城市进行：“极高”（德里）、“高”（孟买、班加罗尔）和“中度”（迈索尔）。研究共纳入4000名参与者（每个城市1000名）。参与者将完成一份结构化问卷，内容涵盖社会人口统计学、哮喘和过敏史（儿童哮喘和过敏国际研究核心问卷）、饮食摄入（24小时回顾法和食物频率问卷）、体力活动-C问卷以及空气污染暴露情况。将使用肺活量测定法和强迫振荡技术评估肺功能。采集血样以鉴定预测肺功能受损的生物标志物。经过质量检查后，将汇总数据，总结肺功能参数以及协变量和混杂因素。方差分析（ANOVA）将评估不同城市之间以及城市内部肺功能的差异。我们预计，与污染程度中等的城市相比，居住在PM水平极高和高的城市中的儿童肺功能下降的患病率更高。本研究的结果可以为印度城市儿童建立适合其年龄的正常肺功能参考值，有助于临床诊断。如果能够找到一种可靠的生物标志物来识别有肺功能受损风险的儿童，它可以作为无症状儿童肺健康不良的早期预测指标。
在研究启动之前，已获得各研究地点机构审查委员会（IRB）的批准，这些机构审查委员会分别来自班加罗尔圣约翰医学院和医院的机构伦理委员会、迈索尔JSS医学院的机构伦理委员会、孟买印度理工学院的学院伦理委员会以及全印度医学科学研究所的学院伦理委员会。本研究的结果将通过会议报告、同行评审出版物以及为生活在印度城市的儿童建立适合其年龄的正常肺功能参考值来进行传播。
