{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T05:12:38Z","timestamp":1790140358904,"version":"4.0.1"},"reference-count":27,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T00:00:00Z","timestamp":1754956800000},"content-version":"unspecified","delay-in-days":11,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009053","name":"Wellcome Trust DBT India Alliance","doi-asserted-by":"publisher","award":["IA\/TSG\/19\/1\/600026"],"award-info":[{"award-number":["IA\/TSG\/19\/1\/600026"]}],"id":[{"id":"10.13039\/501100009053","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,7,18]]},"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>\n                      This longitudinal, prospective cohort study is conducted in four cities categorised by particulate matter 2.5 (PM\n                      <jats:sub>2.5<\/jats:sub>\n                      ) levels: \u2018very high\u2019 (Delhi), \u2018high\u2019 (Mumbai, Bangalore) and \u2018moderate\u2019 (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.\n                    <\/jats:p>\n                    <jats:p>\n                      We anticipate a higher prevalence of reduced lung function in children residing in cities with very high and high PM\n                      <jats:sub>2.5<\/jats:sub>\n                      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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The approval from individual site institutional review board (IRB) is obtained prior to initiation of the study from institutional ethics committee, St. John\u2019s 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-106329","type":"journal-article","created":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T04:30:16Z","timestamp":1755059416000},"page":"e106329","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Rationale and methodology of a multicentric prospective cohort study on \u2018Longitudinal Effects of Air Pollution Exposure on Adolescent Lungs (APEAL)\u2019 in urban India: APEAL protocol"],"prefix":"10.1136","volume":"15","author":[{"given":"Twinkle","family":"Agrawal","sequence":"first","affiliation":[{"name":"Department of Community Health, St John\u2019s National Academy of Health Sciences, Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harish C","family":"Phuleria","sequence":"additional","affiliation":[{"name":"Environmental Science and Engineering Department, Indian Institute of Technology Bombay, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anant","family":"Mohan","sequence":"additional","affiliation":[{"name":"Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"D\u2019Souza","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, St John\u2019s National Academy of Health Sciences, Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajesh","family":"Thimmulappa","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, JSS Medical College, Mysuru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biligere Siddaiah","family":"Jayaraj","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, JSS Medical College, Mysuru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6660-1003","authenticated-orcid":false,"given":"Minu Rose","family":"Mani","sequence":"additional","affiliation":[{"name":"Department of Community Health, St John\u2019s National Academy of Health Sciences, Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Swapnali","family":"Patil","sequence":"additional","affiliation":[{"name":"Environmental Science and Engineering Department, Indian Institute of Technology Bombay, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priya","family":"Samdarshi","sequence":"additional","affiliation":[{"name":"Environmental Science and Engineering Department, Indian Institute of Technology Bombay, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2335-6811","authenticated-orcid":false,"given":"Amruta","family":"Nori-Sarma","sequence":"additional","affiliation":[{"name":"Environmental Health, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0427-7376","authenticated-orcid":false,"given":"Gregory","family":"Wellenius","sequence":"additional","affiliation":[{"name":"Environmental Health, Boston University, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1632-5945","authenticated-orcid":false,"given":"Padukudru Anand","family":"Mahesh","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, JSS Medical College, Mysuru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,8,12]]},"reference":[{"key":"2025123106461373000_15.8.e106329.1","unstructured":"World Health Organisation . 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