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In the California study, suppression of lung function growth by air pollution was clinically significant. For example, the proportion of young adults with an FEV 1 <80% of that expected was four times higher in the community exposed to the highest background level of air pollution than in the least pollution- exposed community. The Children's Health Study also addressed the independent effect of exposure to locally generated air pollution from traffic. 4 Researchers found that children living within 500 m of a heavily used road had 1,450 1,420 1,390 1,360 1,330 1,300 1,270 1,240 1,210 2,485 2,455 2,425 2,395 2,365 2,335 2,305 2,275 2,245 0 0 5 10 15 20 25 30 35 40 Growth in FEV 1 among girls (mL) NO 2 (ppb) Growth in FEV 1 among boys (mL) Girls Boys Fig 11. Average growth in FEV 1 in school-age girls (open circles) and boys (closed circles) during an 8-year period, plotted against average NO 2 . Each dot represents a separate community. As background NO 2 increases in communities, the rate of growth in FEV 1 decreases. A similar effect was observed for background PM. Adapted with permission from Gauderman et al, 5 © 2004 Massachusetts Medical Society. 4 Health effects of air pollution over our lifetime © Royal College of Physicians 2016 53

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