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This study investigated the impact of long-term PM<jats:sub>2.5<\/jats:sub> exposure on respiratory health, lung function growth and fractional exhaled nitric oxide (<jats:italic>F<\/jats:italic>\n                     <jats:sub>ENO<\/jats:sub>) in a large longitudinal cohort of school children.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A total of 6120 elementary school children residing in townships near coal-fired power plants in Taiwan were prospectively enrolled from 2016 to 2018. Baseline and follow-up data on asthmatic symptoms, spirometry, <jats:italic>F<\/jats:italic>\n                     <jats:sub>ENO<\/jats:sub> and environmental factors were collected. Annual PM<jats:sub>2.5<\/jats:sub> exposure was estimated using land-use regression models based on school and home addresses, and associations were adjusted for SO<jats:sub>2<\/jats:sub> and NO<jats:sub>2<\/jats:sub>.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The final analysis included 5364 children and revealed that a 1\u2005\u03bcg\u00b7m<jats:sup>\u22123<\/jats:sup> increase in annual PM<jats:sub>2.5<\/jats:sub> exposure was associated with higher odds of current wheezing (OR 1.07), \u201cever\u201d wheeze (OR 1.03), diagnosed asthma (OR 1.03) and exercise-induced wheeze (OR 1.04) (p&lt;0.05). Each unit increase in PM<jats:sub>2.5<\/jats:sub> exposure was associated with a decrease of 7\u2005mL in forced expiratory volume in 1\u2005s (FEV<jats:sub>1<\/jats:sub>), 5\u2005mL in forced vital capacity (FVC) and a 0.479-ppb rise in <jats:italic>F<\/jats:italic>\n                     <jats:sub>ENO<\/jats:sub> after adjusting for potential confounders (p&lt;0.05). Among 207 new-onset wheezing patients, increased PM<jats:sub>2.5<\/jats:sub> exposure significantly decreased FEV<jats:sub>1<\/jats:sub> by 13\u2005mL and FVC by 15\u2005mL, while increasing <jats:italic>F<\/jats:italic>\n                     <jats:sub>ENO<\/jats:sub> levels by 0.847\u2005ppb (p&lt;0.05).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Long-term PM<jats:sub>2.5<\/jats:sub> exposure significantly increases the risk of asthma symptoms, impedes lung growth and triggers airway inflammation, particularly affecting children with new-onset wheezing in community settings.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1183\/23120541.00972-2024","type":"journal-article","created":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T11:10:45Z","timestamp":1740049845000},"page":"00972-2024","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["Long-term PM<sub>2.5<\/sub> exposure impairs lung growth and increases airway inflammation in Taiwanese school children"],"prefix":"10.1183","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6744-1682","authenticated-orcid":false,"given":"Yi-Giien","family":"Tsai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4540-9822","authenticated-orcid":false,"given":"Jiu-Yao","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuender D.","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5298-2462","authenticated-orcid":false,"given":"Hsiao-Yu","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yen-Po","family":"Yeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Jun","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jui Huan","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu-Li","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shau-Ku","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang-Chuan","family":"Chan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2025,2,20]]},"reference":[{"key":"2025072103300749000_11.4.00972-2024.1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00147-2020"},{"key":"2025072103300749000_11.4.00972-2024.2","doi-asserted-by":"publisher","DOI":"10.1172\/JCI124612"},{"key":"2025072103300749000_11.4.00972-2024.3","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1038\/s41390-023-02977-5","article-title":"Long-term PM2.5 exposure is associated with asthma prevalence and exhaled nitric oxide levels in children","volume":"97","author":"Tsai","year":"2024","journal-title":"Pediatr Res"},{"key":"2025072103300749000_11.4.00972-2024.4","doi-asserted-by":"crossref","first-page":"2254","DOI":"10.1016\/j.jaci.2019.03.024","article-title":"Fine particulate matter exposure during pregnancy and infancy and incident asthma","volume":"143","author":"Jung","year":"2019","journal-title":"J Allergy Clin Immunol"},{"key":"2025072103300749000_11.4.00972-2024.5","doi-asserted-by":"crossref","unstructured":"Chen G , Zhou H , He G , et al. 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