Sources of indoor particulate matter (PM) and outdoor air pollution in China in relation to asthma, wheeze, rhinitis and eczema among pre-school children: Synergistic effects between antibiotics use and PM10 and second hand smoke

We studied indoor sources of indoor particulate matter (PM), outdoor air pollution and antibiotic use in relation to asthma, rhinitis and eczema among pre-school children and investigated synergistic effects between PM and antibiotics use. Children (3-6y) from randomly selected day care centres in seven cities across China were included (n = 39,782). Data on ambient temperature and air pollution were collected from local monitoring stations. Data on indoor PM sources (ETS, burning of incense or mosquito coils and biomass for cooking), antibiotics use and health (doctor diagnosed asthma and rhinitis, lifetime eczema, current wheeze and current rhinitis) were assessed by a parental questionnaire. Associations were calculated by multilevel logistic regression. Asthma diagnosis was associated with outdoor temperature, NO2 and burning mosquito coils. Rhinitis diagnosis was associated with NO2, ETS, gas cooking and burning biomass for cooking. Lifetime eczema was associated with temperature, PM10, NO2, ETS, biomass cooking and burning mosquito coils. Burning incense was associated with current wheeze and current rhinitis. Children using antibiotics had more asthma, wheeze, rhinitis, and eczema. Excluding children with respiratory infections did not change associations with antibiotics use. Antibiotics use enhanced the effects of ETS and PM10 (a synergistic effect). In conclusion, a warmer climate, outdoor NO2 and PM10, ETS, gas cooking and burning biomass, incense and mosquito coils can increase the risk of asthma, wheeze, rhinitis and eczema among pre-school children in China. Antibiotics use is a risk factor for childhood asthma, wheeze, rhinitis and eczema and ETS and outdoor PM10 can enhance the effect.