Influence of air pollution on respiratory health during perinatal development

The respiratory system is a highly ordered structure composed of over 40 cell types involved in a multitude of functions. Development of the lungs spans from embryogenesis to adult life, passing through several distinct stages of growth. Oxidant gases, airborne particles and environmental tobacco smoke are common air pollutants that could have a significant impact on the lungs during both pre- and postnatal periods of life. Although the specific target cells for exposure to these pollutants are not clearly identified, these cells are likely to affect critical signals or mediators expressed during distinct stages of lung development. Neonatal susceptibility to environmental pollutants may be caused by either direct or indirect hits on several cell types to influence cell differentiation, proliferation and/or maturation. Air pollutants may also alter the normal developmental pattern for metabolic, immune and neurological functions that are constantly changing during in utero and postnatal growth. The sensitivity of neonatal cells to environmental insults is likely to be completely different from these same cell types found in the adult. Delivery of an environmental toxicant to the respiratory system is also dramatically different during the fetal compared with the postnatal period. Passage and interaction of environmental factors through other organ systems and the vasculature, as well as maternal influences, must be taken into consideration when evaluating the impact of an environmental toxicant during early life. To understand the heath outcomes of exposure to a variety of environmental factors in the respiratory system of children requires careful consideration that lung development is a multistep process and cannot be based on studies in adults.