{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T21:05:16Z","timestamp":1777064716843,"version":"3.51.4"},"reference-count":99,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2022,3,8]],"date-time":"2022-03-08T00:00:00Z","timestamp":1646697600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Atmosphere"],"abstract":"<jats:p>Background: Ground-level ozone has been gaining notoriety with increasing evidence of its nefarious effects on health, especially respiratory diseases. Where do we stand on the solidity of this data and is there room for improvement? Objectives: Evaluate this evidence for incongruities or heterogeneity in this field of research. How is the exposure assessment conducted, where does Portugal stand in this field, and what can be improved? Health deterioration concerning asthma, chronic obstructive pulmonary disease (COPD), and acute respiratory distress syndrome (ARDS) are analysed. Methods: A review of 1735 studies was conducted through PubMed and Google Scholar engines for the past two decades. We identified 59 eligible studies and included an array of variables, including O3 measurements, number of air-quality monitoring stations used, relative risks, odds ratios, hazard ratios, number of hospital admissions, visits, or mortality, and size of population dataset used. Results: Approximately 83% of data in this review presents significant correlations of ozone with asthma, COPD, and ARDS. Studies that report negative or not significant associations mention a lack of data or topographic differences as the main issue with these divergent results. Studies consistently report summer as a period of particular concern. Portuguese data in this field is lacking. Conclusions: This research field is growing in interest and there is evidence that ozone plays a non-negligible role in health deterioration. The few Portuguese studies in this field seem aligned with the literature reviewed but more research is needed. Suggested improvements are more and better data through denser air-quality networks to accurately depict personal exposure to ozone. Homogenization of the exposure assessment concerning averaging times of ozone to daily maximum 8 h averages whenever possible. Risk increments based on 10 ppb instead of interquartile ranges. Lastly, contrary to some studies in this review, the topographic effect on concentrations and health deterioration should not be underestimated and seasonality should always be checked.<\/jats:p>","DOI":"10.3390\/atmos13030434","type":"journal-article","created":{"date-parts":[[2022,3,8]],"date-time":"2022-03-08T12:35:37Z","timestamp":1646742937000},"page":"434","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Review of Ground-Level Ozone Impact in Respiratory Health Deterioration for the Past Two Decades"],"prefix":"10.3390","volume":"13","author":[{"given":"Angelo Rold\u00e3o","family":"Soares","sequence":"first","affiliation":[{"name":"Instituto Dom Luiz (IDL), Faculdade de Ci\u00eancias da Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1439-9214","authenticated-orcid":false,"given":"Carla","family":"Silva","sequence":"additional","affiliation":[{"name":"Instituto Dom Luiz (IDL), Faculdade de Ci\u00eancias da Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,8]]},"reference":[{"key":"ref_1","first-page":"774","article-title":"The Clean Air Act, 1956; initial steps for implementation","volume":"77","author":"Lavender","year":"1957","journal-title":"R. Soc. Health J."},{"key":"ref_2","unstructured":"EPA (2021, December 24). Air Quality Criteria for Photochemical Oxidants, Available online: https:\/\/nepis.epa.gov\/Exe\/ZyPDF.cgi\/9100E2Z7.PDF?Dockey=9100E2Z7.PDF."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1007\/s00420-017-1270-7","article-title":"Ambient air pollution and emergency department visits for asthma in Erie County, New York 2007\u20132012","volume":"91","author":"Castner","year":"2017","journal-title":"Int. Arch. Occup. Environ. Health"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1164\/rccm.201803-0435OC","article-title":"Low to Moderate Air Pollutant Exposure and Acute Respiratory Distress Syndrome after Severe Trauma","volume":"199","author":"Reilly","year":"2018","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1186\/s12940-016-0196-y","article-title":"Pediatric emergency department visits and ambient Air pollution in the U.S. State of Georgia: A case-crossover study","volume":"15","author":"Xiao","year":"2016","journal-title":"Environ. Health"},{"key":"ref_6","unstructured":"World Health Organization (2013). Review of Evidence on Health Aspects of Air Pollution\u2013REVIHAAP Project: Technical Report, World Health Organization. Technical Report."},{"key":"ref_7","first-page":"672","article-title":"Health Effects Of Ozone A Critical Review","volume":"39","author":"Lippmann","year":"1989","journal-title":"J. Air Pollut. Control Assoc."},{"key":"ref_8","unstructured":"Pennsylvania Department of Environmental Protection (2012, June 09). Ozone Standard, Available online: https:\/\/www.dep.pa.gov\/Business\/Air\/BAQ\/PollutantTopics\/Pages\/Ozone-Standard.aspx."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1513","DOI":"10.1016\/j.freeradbiomed.2010.02.032","article-title":"Apoptosis induced by ozone and oxysterols in human alveolar epithelial cells","volume":"48","author":"Kosmider","year":"2010","journal-title":"Free Radic. Biol. Med."},{"key":"ref_10","unstructured":"US EPA (2020). Integrated Science Assessment (ISA) for Ozone and Related Photochemical Oxidants (Final Report)."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Salam, M.T., Islam, T., and Gilliland, F.D. (2008). Recent evidence for adverse effects of residential proximity to traffic sources on asthma. Current Opinion in Pulmonary Medicine, Wolters Kluwer Health, Inc.","DOI":"10.1097\/MCP.0b013e3282f1987a"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"470","DOI":"10.3109\/02770903.2011.570407","article-title":"Outdoor air pollution and asthma in children","volume":"48","author":"Tzivian","year":"2011","journal-title":"J. Asthma"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1056\/NEJMoa0803894","article-title":"Long-Term Ozone Exposure and Mortality","volume":"360","author":"Jerrett","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1016\/S0140-6736(20)30925-9","article-title":"Global burden of 369 diseases and injuries in 204 countries and territories, 1990\u20132019: A systematic analysis for the Global Burden of Disease Study 2019","volume":"396","author":"Vos","year":"2020","journal-title":"Lancet"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Zheng, X.Y., Ding, H., Jiang, L.N., Chen, S.W., Zheng, J.P., Qiu, M., Zhou, Y.X., Chen, Q., and Guan, W.J. (2015). Association between Air Pollutants and Asthma Emergency Room Visits and Hospital Admissions in Time Series Studies: A Systematic Review and Meta-Analysis. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0138146"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1378\/chest.07-1131","article-title":"COPD in Asia","volume":"133","author":"Tan","year":"2008","journal-title":"Chest"},{"key":"ref_17","unstructured":"World Health Organization (2020). The Top 10 Causes of Death, World Health Organization."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1016\/j.envpol.2017.02.014","article-title":"Association between chronic exposure to air pollution and mortality in the acute respiratory distress syndrome","volume":"224","author":"Rush","year":"2017","journal-title":"Environ. Pollut."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2518","DOI":"10.3389\/fimmu.2019.02518","article-title":"Ozone Pollution: A Major Health Hazard Worldwide","volume":"10","author":"Zhang","year":"2019","journal-title":"Front. Immunol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1080\/10473289.1995.10467428","article-title":"Weekday vs. Weekend Ambient Ozone Concentrations: Discussion and Hypotheses with Focus on Northern California","volume":"45","author":"Altshuler","year":"1995","journal-title":"J. Air Waste Manag. Assoc."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Soares, A.R., Deus, R., Barroso, C., and Silva, C. (2021). Urban ground-level o3 trends: Lessons from portuguese cities, 2010\u20132018. Atmosphere, 12.","DOI":"10.3390\/atmos12020183"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/S1001-0742(13)60377-0","article-title":"Fast increasing of surface ozone concentrations in Pearl River Delta characterized by a regional air quality monitoring network during 2006\u20132011","volume":"26","author":"Li","year":"2014","journal-title":"J. Environ. Sci."},{"key":"ref_23","first-page":"141978","article-title":"Impact of COVID-19 lockdown on NO2, O3, PM2.5 and PM10 concentrations and assessing air quality changes in Baghdad, Iraq","volume":"754","author":"Hashim","year":"2021","journal-title":"Sci. Environ."},{"key":"ref_24","unstructured":"World Health Organization (2014). WHO Expert Meeting: Methods and Tools for Assessing the Health Risks of Air Pollution at Local, National and International Level, WHO Regional Office for Europe."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"3531","DOI":"10.1029\/1999JD901011","article-title":"What controls tropospheric ozone?","volume":"105","author":"Lelieveld","year":"2000","journal-title":"J. Geophys. Res. Atmos."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2063","DOI":"10.1016\/S1352-2310(99)00460-4","article-title":"Atmospheric chemistry of VOCs and NO(x)","volume":"34","author":"Atkinson","year":"2000","journal-title":"Atmos. Environ."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Akimoto, H. (2016). Atmospheric Reaction Chemistry, Springer.","DOI":"10.1007\/978-4-431-55870-5"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1111\/j.1539-6924.2011.01630.x","article-title":"Estimating the National Public Health Burden Associated with Exposure to Ambient PM2.5 and Ozone","volume":"32","author":"Fann","year":"2011","journal-title":"Risk Anal."},{"key":"ref_29","unstructured":"Guerreiro, C., Leeuw, F., and Ortiz, A.G. (2018). Air Quality in Europe\u20142018 Report, Technical Report."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1016\/j.crte.2007.08.005","article-title":"Human mortality effects of future concentrations of tropospheric ozone","volume":"339","author":"West","year":"2007","journal-title":"C. R. Geosci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.envpol.2011.10.019","article-title":"Ozone weekend effect in Santiago, Chile","volume":"162","author":"Seguel","year":"2012","journal-title":"Environ. Pollut."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"110193","DOI":"10.1016\/j.envres.2020.110193","article-title":"Ozone weekend effect in cities: Deep insights for urban air pollution control","volume":"191","author":"Sicard","year":"2020","journal-title":"Environ. Res."},{"key":"ref_33","unstructured":"da Sa\u00fade, M., and da Sa\u00fade, D. (2021, December 24). PROGRAMA NACIONAL PARA AS DOEN\u00c7AS RESPIRAT\u00d3RIAS. Available online: http:\/\/3r.web.ua.pt\/wp-content\/uploads\/2019\/01\/Programa_nacional_doencas_respiratorias.pdf."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1016\/j.scitotenv.2019.06.382","article-title":"Effects of ambient ozone concentrations with different averaging times on asthma exacerbations: A meta-analysis","volume":"691","author":"Li","year":"2019","journal-title":"Sci. Total Environ."},{"key":"ref_35","first-page":"e10047","article-title":"What\u2019s the Risk: Differentiating Risk Ratios, Odds Ratios, and Hazard Ratios?","volume":"12","author":"George","year":"2020","journal-title":"Cureus"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1038\/jes.2015.57","article-title":"Ambient air pollution and emergency department visits for asthma: A multi-city assessment of effect modification by age","volume":"26","author":"Alhanti","year":"2015","journal-title":"J. Expo. Sci. Environ. Epidemiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2357","DOI":"10.1007\/s11357-013-9510-6","article-title":"Redefining meaningful age groups in the context of disease","volume":"35","author":"Geifman","year":"2013","journal-title":"Age"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1080\/00207230500367879","article-title":"Air pollution and daily hospitalization rates for cardiovascular and respiratory diseases in London, Ontario","volume":"62","author":"Fung","year":"2005","journal-title":"Int. J. Environ. Stud."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1138","DOI":"10.1111\/j.1365-2222.2006.02555.x","article-title":"Association between air pollution and asthma admission among children in Hong Kong","volume":"36","author":"Lee","year":"2006","journal-title":"Clin. Exp. Allergy"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1312","DOI":"10.1111\/j.1365-2222.2007.02791.x","article-title":"Effects of air pollution on asthma hospitalization rates in different age groups in Hong Kong Clinical and Experimental Allergy","volume":"37","author":"Ko","year":"2007","journal-title":"Clin. Exp. Allergy"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1097\/01.PHH.0000338371.53242.0e","article-title":"Tracking Associations Between Ambient Ozone and Asthma-Related Emergency Department Visits Using Case-Crossover Analysis","volume":"14","author":"Paulu","year":"2008","journal-title":"J. Public Health Manag. Pract."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1136\/jech.2009.087106","article-title":"Ozone and cause-specific cardiorespiratory morbidity and mortality","volume":"64","author":"Halonen","year":"2010","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1016\/S1081-1206(10)60263-3","article-title":"Relationship between visits to emergency departments for asthma and ozone exposure in greater Seattle, Washington","volume":"103","author":"Mar","year":"2009","journal-title":"Ann. Allergy Asthma Immunol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/j.jaci.2009.10.061","article-title":"Age-related association of fine particles and ozone with severe acute asthma in New York City","volume":"125","author":"Silverman","year":"2010","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/1476-069X-8-25","article-title":"Environmental Health Air pollution and emergency department visits for cardiac and respiratory conditions: A multi-city time-series analysis","volume":"8","author":"Stieb","year":"2009","journal-title":"Environ. Health"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1590\/S0100-40422010000200020","article-title":"Air pollution and emergency admissions for cardiorespiratory diseases in Lisbon (Portugal)","volume":"33","author":"Alves","year":"2010","journal-title":"Qu\u00edmica Nova"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/09603120903254033","article-title":"Relationship between ambient ozone concentrations and daily hospital admissions for childhood asthma\/atopic dermatitis in two cities of Korea during 2004\u20132005","volume":"20","author":"Lee","year":"2010","journal-title":"Int. J. Environ. Health Res."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1136\/jech.2009.083576","article-title":"Outdoor air pollution and uncontrolled asthma in the San Joaquin Valley, California","volume":"64","author":"Meng","year":"2010","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1016\/j.envres.2011.01.024","article-title":"Short-term association between exposure to ozone and mortality in Oporto, Portugal","volume":"111","author":"Casimiro","year":"2011","journal-title":"Environ. Res."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1164\/rccm.201102-0227OC","article-title":"Ozone and Survival in Four Cohorts with Potentially Predisposing Diseases","volume":"184","author":"Zanobetti","year":"2011","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1186\/1465-9921-13-95","article-title":"How air pollution influences clinical management of respiratory diseases. A case-crossover study in Milan","volume":"13","author":"Santus","year":"2012","journal-title":"Respir. Res."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1289\/ehp.1306940","article-title":"Influence of urbanicity and county characteristics on the association between ozone and asthma emergency department visits in North Carolina","volume":"122","author":"Sacks","year":"2014","journal-title":"Environ. Health Perspect."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1080\/15287394.2014.887399","article-title":"Effects of Exposure to Particles and Ozone on Hospital Admissions for Cardiorespiratory Diseases in Set\u00faBal, Portugal","volume":"77","author":"Almeida","year":"2014","journal-title":"J. Toxicol. Environ. Health"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.envres.2014.02.013","article-title":"Association of short-term increases in ambient air pollution and timing of initial asthma diagnosis among medicaid-enrolled children in a metropolitan area","volume":"131","author":"Wendt","year":"2014","journal-title":"Environ. Res."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"245","DOI":"10.3109\/02770903.2015.1091006","article-title":"Short-term effects of ambient air pollutants on asthma-related emergency department visits in Indianapolis, Indiana, 2007\u20132011","volume":"53","author":"Byers","year":"2007","journal-title":"J. Asthma"},{"key":"ref_56","unstructured":"Gleason, J.A., and Fagliano, J.A. (2015). Early Online: 1-8 !. J. Asthma, 1532\u20134303."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.envpol.2015.03.040","article-title":"Hourly differences in air pollution on the risk of asthma exacerbation","volume":"203","author":"Kim","year":"2015","journal-title":"Environ. Pollut."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s12940-015-0010-2","article-title":"Ambient ozone exposure and children\u2019s acute asthma in New York City: A case-crossover analysis","volume":"14","author":"Sheffield","year":"2011","journal-title":"Environ. Health"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"e005736","DOI":"10.1136\/bmjopen-2014-005736","article-title":"Exposure to air pollution and meteorological factors associated with children\u2019s primary care visits at night due to asthma attack: Case-crossover design for 3-year pooled patients","volume":"5","author":"Yamazaki","year":"2015","journal-title":"BMJ Open"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"2781","DOI":"10.1007\/s11356-016-8038-6","article-title":"Exposure to PM10, NO2, and O3 and impacts on human health","volume":"24","author":"Khaniabadi","year":"2016","journal-title":"Environ. Sci. Pollut. Res."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1136\/thoraxjnl-2015-208054","article-title":"The short-term association between asthma hospitalisations, ambient temperature, other meteorological factors and air pollutants in Hong Kong: A time-series study","volume":"71","author":"Lam","year":"2016","journal-title":"Thorax"},{"key":"ref_62","first-page":"8","article-title":"Association Between Asthma Hospital Visits and Ozone Concentration in Maricopa County, Arizona (2007\u20132012)","volume":"78","author":"Mohamed","year":"2016","journal-title":"J. Environ. Health"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"329","DOI":"10.3961\/jpmph.16.038","article-title":"Short-term Effects of Ambient Air Pollution on Emergency Department Visits for Asthma: An Assessment of Effect Modification by Prior Allergic Disease History","volume":"49","author":"Noh","year":"2016","journal-title":"J. Prev. Med. Public Health"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1164\/rccm.201507-1418OC","article-title":"Long-Term Ozone Exposure Increases the Risk of Developing the Acute Respiratory Distress Syndrome","volume":"193","author":"Ware","year":"2016","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1016\/j.envpol.2016.09.070","article-title":"Air pollution and asthma attacks in children: A case-crossover analysis in the city of Chongqing, China","volume":"220","author":"Ding","year":"2017","journal-title":"Environ. Pollut."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"e0180522","DOI":"10.1371\/journal.pone.0180522","article-title":"Impact of respiratory infections, outdoor pollen, and socioeconomic status on associations between air pollutants and pediatric asthma hospital admissions","volume":"12","author":"Goodman","year":"2017","journal-title":"PloS ONE"},{"key":"ref_67","first-page":"139","article-title":"Acute effects of ambient air pollution on lower respiratory infections in Hanoi children: An eight-year time series study","volume":"110","author":"Thi","year":"2017","journal-title":"Environ. Int."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"117006","DOI":"10.1289\/EHP1849","article-title":"Ambient Ozone Pollution and Daily Mortality: A Nationwide Study in 272 Chinese Cities","volume":"125","author":"Yin","year":"2017","journal-title":"Environ. Health Perspect."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.envint.2017.04.006","article-title":"Concentration-response of short-term ozone exposure and hospital admissions for asthma in Texas","volume":"104","author":"Zu","year":"2017","journal-title":"Environ. Int."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1080\/02770903.2018.1523930","article-title":"Ozone pollution and asthma emergency department visits in the Central Valley, California, USA, during June to September of 2015: A time-stratified case-crossover analysis","volume":"56","author":"Gharibi","year":"2019","journal-title":"J. Asthma"},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Qiu, H., Tan, K., Long, F., Wang, L., Yu, H., Deng, R., Long, H., Zhang, Y., and Pan, J. (2018). The Burden of COPD Morbidity Attributable to the Interaction between Ambient Air Pollution and Temperature in Chengdu, China. Int. J. Environ. Res. Public Health, 15.","DOI":"10.3390\/ijerph15030492"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1164\/rccm.201806-1147OC","article-title":"Age-specific associations of ozone and PM 2.5 with respiratory emergency department visits in the US","volume":"199","author":"Strosnider","year":"2019","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Zielinski, M., Gasior, M., Jastrzebski, D., Desperak, A., and Ziora, D. (2018). Influence of Gaseous Pollutants on COPD Exacerbations in Patients with Cardiovascular Comorbidities. Clinical Pulmonary Research, Springer.","DOI":"10.1007\/5584_2018_206"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1038\/s41370-019-0135-4","article-title":"Long-term ozone exposures and cause-specific mortality in a US Medicare cohort","volume":"30","author":"Kazemiparkouhi","year":"2020","journal-title":"J. Expo. Sci. Environ. Epidemiol."},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Kuo, C.Y., Chan, C.K., Wu, C.Y., Phan, D.V., and Chan, C.L. (2019). The Short-Term Effects of Ambient Air Pollutants on Childhood Asthma Hospitalization in Taiwan: A National Study. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16020203"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1542","DOI":"10.1016\/j.jaci.2019.08.037","article-title":"Short-term effects of multiple outdoor environmental factors on risk of asthma exacerbations: Age-stratified time-series analysis","volume":"144","author":"Lee","year":"2019","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"e270","DOI":"10.1016\/S2542-5196(19)30085-3","article-title":"Associations between daily air quality and hospitalisations for acute exacerbation of chronic obstructive pulmonary disease in Beijing, 2013\u20132017: An ecological analysis","volume":"3","author":"Liang","year":"2019","journal-title":"Lancet Planet. Health"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1164\/rccm.201806-1161OC","article-title":"Long-Term Exposure to Ozone and Cause-Specific Mortality Risk in the United States","volume":"200","author":"Lim","year":"2019","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1164\/rccm.201810-1823OC","article-title":"Short-Term Exposure to Ambient Air Pollution and Asthma Mortality","volume":"200","author":"Liu","year":"2019","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.chest.2019.03.017","article-title":"Impact of Long-Term Exposures to Ambient PM 2.5 and Ozone on ARDS Risk for Older Adults in the United States","volume":"156","author":"Rhee","year":"2019","journal-title":"Chest"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"104879","DOI":"10.1016\/j.envint.2019.05.073","article-title":"Long-term exposure to PM 2.5 and ozone and hospital admissions of Medicare participants in the Southeast USA","volume":"130","author":"Wang","year":"2019","journal-title":"Environ. Int."},{"key":"ref_82","doi-asserted-by":"crossref","unstructured":"Baek, J., Kash, B.A., Xu, X., Benden, M., Roberts, J., and Carrillo, G. (2020). Effect of Ambient Air Pollution on Hospital Readmissions among the Pediatric Asthma Patient Population in South Texas: A Case-Crossover Study. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17134846"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1007\/s00484-020-01934-9","article-title":"Association between air pollutants and outpatient and emergency hospital visits for childhood asthma in Shenyang city of China","volume":"64","author":"Chang","year":"2020","journal-title":"Int. J. Biometeorol."},{"key":"ref_84","doi-asserted-by":"crossref","unstructured":"Franco, P., Gordo, C., da Costa, E.M., and Lopes, A. (2020). Air Pollution and Emergency Hospital Admissions\u2014Evidences from Lisbon Metropolitan Area, Portugal. Appl. Sci., 10.","DOI":"10.3390\/app10227997"},{"key":"ref_85","doi-asserted-by":"crossref","unstructured":"Niewiadomska, E., Kowalska, M., Niewiadomski, A., Skrzypek, M., and Kowalski, M.A. (2020). Assessment of Risk Hospitalization due to Acute Respiratory Incidents Related to Ozone Exposure in Silesian Voivodeship (Poland). Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17103591"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1001\/jamainternmed.2019.5498","article-title":"Association of Long-term Ambient Ozone Exposure With Respiratory Morbidity in Smokers","volume":"180","author":"Paulin","year":"2020","journal-title":"JAMA Intern. Med."},{"key":"ref_87","first-page":"875","article-title":"Effects of air pollution on moderate and severe asthma exacerbations","volume":"57","author":"Shin","year":"2020","journal-title":"J. Asthma Off. J. Assoc. Care Asthma"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s12199-020-00925-x","article-title":"Effects of short-term exposure to ambient airborne pollutants on COPD-related mortality among the elderly residents of Chengdu city in Southwest China","volume":"26","author":"Chen","year":"2021","journal-title":"Environ. Health Prev. Med."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"110955","DOI":"10.1016\/j.envres.2021.110955","article-title":"Effects of ambient air pollution on childhood asthma exacerbation in the Philadelphia metropolitan Region, 2011\u20132014","volume":"197","author":"Huang","year":"2021","journal-title":"Environ. Res."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"142110","DOI":"10.1016\/j.scitotenv.2020.142110","article-title":"Association between ambient ozone pollution and mortality from a spectrum of causes in Guangzhou, China","volume":"754","author":"Li","year":"2021","journal-title":"Sci. Total Environ."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"1138","DOI":"10.1164\/rccm.201909-1744OC","article-title":"Air pollution as a risk factor for incident chronic obstructive pulmonary disease and Asthma: A 15-year population-based cohort study","volume":"203","author":"Shin","year":"2021","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_92","doi-asserted-by":"crossref","unstructured":"Gao, H., Wang, K., Au, W.W., Zhao, W., and Xia, Z.L. (2020). A Systematic Review and Meta-Analysis of Short-Term Ambient Ozone Exposure and COPD Hospitalizations. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17062130"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"1294","DOI":"10.1016\/j.envsoft.2006.08.004","article-title":"Influence of initial and boundary conditions for ozone modeling in very complex terrains: A case study in the northeastern Iberian Peninsula","volume":"22","author":"Parra","year":"2007","journal-title":"Environ. Model. Softw."},{"key":"ref_94","first-page":"562","article-title":"Acute Respiratory Distress Syndrome","volume":"377","author":"Thompson","year":"2017","journal-title":"JAMA"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1164\/rccm.201211-1969OC","article-title":"Heat-related emergency hospitalizations for respiratory diseases in the medicare population","volume":"187","author":"Anderson","year":"2013","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"1980","DOI":"10.1152\/japplphysiol.00301.2010","article-title":"Heat stroke: Role of the systemic inflammatory response","volume":"109","author":"Leon","year":"2010","journal-title":"J. Appl. Physiol."},{"key":"ref_97","unstructured":"United States Environmental Protection Agency (1998). Guideline on Data Handling Conventions for the 8-h Ozone Naaqs."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1080\/00022470.1975.10470171","article-title":"Interpreting the eight-hour national ambient air quality standard for carbon monoxide","volume":"25","author":"Mcmullen","year":"2012","journal-title":"J. Air Pollut. Control Assoc."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1097\/EDE.0000000000000236","article-title":"Framing air pollution epidemiology in terms of population interventions, with applications to multi-pollutant modeling","volume":"26","author":"Snowden","year":"2015","journal-title":"Epidemiology"}],"container-title":["Atmosphere"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2073-4433\/13\/3\/434\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:33:59Z","timestamp":1760135639000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2073-4433\/13\/3\/434"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,8]]},"references-count":99,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,3]]}},"alternative-id":["atmos13030434"],"URL":"https:\/\/doi.org\/10.3390\/atmos13030434","relation":{},"ISSN":["2073-4433"],"issn-type":[{"value":"2073-4433","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,8]]}}}