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Published by Oxford University Press on behalf of the International Epidemiological Association lnrernanonal Journal of Epidemiology 2013:42:17241737 �t3 The Author 200: all rights reserved. Advance Access publication 20 August 2013 dry: 10. 1 093/ile/dytl 50 EARLY LIFE Meta-analysis of the effects of indoor nitrogen dioxide and gas cooking on asthma and wheeze in children Weiwei Lin,' Bert Brunekreef',2 and Ulrike Gehring'* 'Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands and 'Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands *Corresponding author. Institute for Risk Assessment Sciences, Utrecht University, PO Box 80178, 3508 TD Utrecht, The Netherlands. E-mail u.gehring tduu.nl Introduction Accepted 25 June 2013 Background Since the meta-analysis on the association between indoor nitrogen dioxide (NO2) and childhood respiratory illness in 1992, many new studies have been published. The quantitative effects of indoor NO2 on respiratory illness have not been estimated in a formal meta- analysis since then. We aimed to quantify the association of indoor NO2 and its main source (gas cooking) with childhood asthma and wheeze. Methods We extracted the association between indoor NO2 (and gas cook- ing) and childhood asthma and wheeze from population studies published up to 31 March 2013. Data were analysed by inverse - variance -weighted, random -effects meta-analysis. Sensitivity analyses were conducted for different strata. Publication bias and heterogeneity between studies were investigated. Results A total of 41 studies met the inclusion criteria. The summary odds ratio from random effects meta-analysis for asthma and gas cook- ing exposure was 1.32 [95% confidential interval (CI) 1.18-1.48], and for a 15 -ppb increase in NO2 it was 1.09 (95% CI 0.91-1.31). Indoor NO2 was associated with current wheeze (random effects OR 1.15; 95% CI 1.06-1.25). The estimates did not vary much with age or between regions. There was no evidence of publication bias. Conclusions This meta-analysis provides quantitative evidence that, in children, gas cooking increases the risk of asthma and indoor NO, increases the risk of current wheeze. Keywords Asthma, wheeze, gas cooking, indoor pollution, infant, review exacerbate asthma, especially in children." One reason is the long periods of time that children The association between adverse health consequences spend indoors .5 and indoor nitrogen dioxide (NO2) exposure has been In 1992, Hasselblad et al.' carried out a meta - the subject of many studies. Indoor NO2 exposure analysis including 11 studies, which concluded that may increase the risk of acute and chronic respiratory children exposed to a long-term increase of 15 ppb illnesses, reduce lung function and initiate and NO2 indoors suffer a 20% increase in respiratory 1724 e