{
  "abstract": "Introduction Air pollution is a significant global health concern, with studies from the USA and Europe linking long-term exposure to respiratory issues and poor school attendance in children. While Indian cities experience much higher pollution levels, the impact on lung development in Indian children remains unclear. This study aims to assess the burden of impaired lung function in Indian children and identify key factors contributing to pollution-induced lung injury.Methods and analysis This longitudinal, prospective cohort study is conducted in four cities categorised by particulate matter 2.5 (PM 2.5) levels: ‘very high’ (Delhi), ‘high’ (Mumbai, Bangalore) and ‘moderate’ (Mysore). A total of 4000 participants (1000 from each city) will be included in the study. Participants will complete a structured questionnaire covering sociodemographics, asthma and allergy history (International Study of Asthma and Allergies in Childhood core questionnaire), dietary intake (24-hour recall and Food Frequency Questionnaire), Physical Activity-C Questionnaire and air pollution exposure. Spirometry and Forced Oscillation Technique will be used to assess lung function. Blood samples will be collected for identification of biomarkers to predict lung impairment. After quality checks, data will be compiled, summarising pulmonary function parameters alongside covariates and confounders. Analysis of Variance (ANOVA) will assess between-city and within-city differences in lung function.We anticipate a higher prevalence of reduced lung function in children residing in cities with very high and high PM2.5 levels compared with the moderately polluted city. Findings from this study could establish normal age-appropriate lung function reference values for Indian urban children, aiding in clinical diagnosis.If a reliable biomarker for identifying children at risk of lung impairment is available, it could serve as an early predictor of poor lung health in asymptomatic children.Ethics and dissemination The approval from individual site institutional review board (IRB) is obtained prior to initiation of the study from institutional ethics committee, St. John’s Medical College and Hospital, Bangalore; institutional ethics committee, JSS Medical College, Mysore; institute ethics committee, Indian Institute of Technology Bombay and institute ethics committee, All India Institute of Medical Sciences. Findings from this study will be disseminated through conference presentations, peer-reviewed publications and establishment of normal age-appropriate lung function reference values for children living in urban India.",
  "authors": [
    {
      "affiliations": [
        "Department of Community Health, St John’s National Academy of Health Sciences, Bengaluru, Karnataka, India"
      ],
      "name": "Twinkle Agrawal"
    },
    {
      "affiliations": [
        "Environmental Science and Engineering Department, Indian Institute of Technology Bombay, Mumbai, Maharashtra, India"
      ],
      "name": "Harish C Phuleria"
    },
    {
      "affiliations": [
        "Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi, India"
      ],
      "name": "Anant Mohan"
    },
    {
      "affiliations": [
        "Department of Pulmonary Medicine, St John’s National Academy of Health Sciences, Bengaluru, Karnataka, India"
      ],
      "name": "George D’Souza"
    },
    {
      "affiliations": [
        "Department of Biochemistry, JSS Medical College, Mysuru, Karnataka, India"
      ],
      "name": "Rajesh Thimmulappa"
    },
    {
      "affiliations": [
        "Department of Respiratory Medicine, JSS Medical College, Mysuru, Karnataka, India"
      ],
      "name": "Biligere Siddaiah Jayaraj"
    },
    {
      "affiliations": [
        "Department of Community Health, St John’s National Academy of Health Sciences, Bengaluru, Karnataka, India"
      ],
      "name": "Minu Rose Mani"
    },
    {
      "affiliations": [
        "Environmental Science and Engineering Department, Indian Institute of Technology Bombay, Mumbai, Maharashtra, India"
      ],
      "name": "Swapnali Patil"
    },
    {
      "affiliations": [
        "Environmental Science and Engineering Department, Indian Institute of Technology Bombay, Mumbai, Maharashtra, India"
      ],
      "name": "Priya Samdarshi"
    },
    {
      "affiliations": [
        "Environmental Health, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA"
      ],
      "name": "Amruta Nori-Sarma"
    },
    {
      "affiliations": [
        "Environmental Health, Boston University, Boston, Massachusetts, USA"
      ],
      "name": "Gregory Wellenius"
    },
    {
      "affiliations": [
        "Department of Respiratory Medicine, JSS Medical College, Mysuru, Karnataka, India"
      ],
      "name": "Padukudru Anand Mahesh"
    }
  ],
  "title": "Rationale and methodology of a multicentric prospective cohort study on ‘Longitudinal Effects of Air Pollution Exposure on Adolescent Lungs (APEAL)’ in urban India: APEAL protocol",
  "uid": "0c41551a-9e4f-587b-890c-6f75a73d1f58"
}