Article Text

Original article
Poor air quality in classrooms related to asthma and rhinitis in primary schoolchildren of the French 6 Cities Study
  1. Isabella Annesi-Maesano1,2,
  2. Marion Hulin1,2,
  3. François Lavaud3,
  4. Chantal Raherison4,5,
  5. Christine Kopferschmitt6,
  6. Frederic de Blay6,
  7. Denis André Charpin7,
  8. Caillaud Denis8
  1. 1EPAR, INSERM, Paris, France
  2. 2EPAR, Université Pierre et Marie Curie, Paris, France
  3. 3Hôpital Maison Blanche, Reims, France
  4. 4Hôpital du Haut-Lévèque, Bordeaux, France
  5. 5ISPED Université, Bordeaux, France
  6. 6Hôpitaux Civils, Strasbourg, France
  7. 7Hôpital Nord, Marseille, France
  8. 8Hôpital Montpied, Clermont-Ferrand, France
  1. Correspondence to Dr Isabella Annesi-Maesano, Epidemiology of Allergic and Respiratory Diseases (EPAR), UMR S 707, INSERM-UPMC-Paris 6, Medical School St Antoine, 27 rue Chaligny, Paris 75571 Cedex 12, France; isabella.annesi-maesano{at}


Background Relationships between indoor air quality (IAQ) found in schools and the allergic and respiratory health of schoolchildren have been insufficiently explored. A survey was conducted in a large sample of classrooms of primary schools in France to provide objective assessments of IAQ to which young schoolchildren are exposed in classrooms, and to relate exposure to major air pollutants found in classrooms to asthma and allergies of schoolchildren.

Methods Concentrations of fine particles with aerodynamic diameter ≤2.5 μm (PM2.5), nitrogen dioxide (NO2) and three aldehydes were objectively assessed in 401 randomly chosen classrooms in 108 primary schools attended by 6590 children (mean age 10.4 years, SD ±0.7) in the French 6 Cities Study. The survey incorporated a medical visit including skin prick testing (SPT) for common allergens, a test for screening exercise-induced asthma (EIA) and a standardised health questionnaire completed by parents.

Results Children were differently exposed to poor air quality in classrooms, with almost 30% being highly exposed according to available standards. After adjusting for confounders, past year rhinoconjunctivitis was significantly associated with high levels of formaldehyde in classrooms (OR 1.19; 95% CI 1.04 to 1.36). Additionally, an increased prevalence of past year asthma was found in the classrooms with high levels of PM2.5 (OR 1.21; 95% CI 1.05 to 1.39), acrolein (OR 1.22; 95% CI 1.09 to 1.38) and NO2 (OR 1.16; 95% CI 0.95 to 1.41) compared with others. The relationship was observed mostly for allergic asthma as defined using SPT. A significant positive correlation was found between EIA and the levels of PM2.5 and acrolein in the same week.

Conclusions In this random sample, air quality in classrooms was poor, varied significantly among schools and cities, and was related to an increased prevalence of clinical manifestations of asthma and rhinitis in schoolchildren. Children with a background of allergies seemed at increased risk.

  • PM2.5
  • NO2
  • FA
  • VOC
  • asthma
  • allergic rhinitis
  • skin prick test positivity
  • asthma epidemiology
  • COPD epidemiology
  • paediatric asthma
  • tobacco and the lung
  • respiratory muscles
  • assisted ventilation

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • Funding The French 6 Cities Study was supported by National Institute for Health and Medical Research (INSERM) (Programme Déterminants de la Santé), Ministry of Health (DGS), Environmental Programme PRIMEQUAL-PREDIT, Agence de la Maîtrise de l'Energie (ADEME), Mutuelle Générale de l'Education Nationale (MGEN), Agence Française de Sécurité Sanitaire de l'Environnement et du Travail (AFSSET) and ANTADIR.

  • Competing interests None.

  • Patient consent obtained.

  • Ethics approval French CCPPRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The 6 Cities Study should allow investigation of the relationship between stress, air pollution, asthma and allergies.

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