tests also did not differ statistically significantly between target and comparison communities. Subjects with a history of recent wheeze or other asthma-like symptoms and nonsmoking subjects with no history of respiratory symptoms were recruited from each study community to record twice-daily peak expiratory-flow rates, acute respiratory symptoms, and (among asthmatics) use of asthma medications for 35 consecutive days during each year of study. None of the paired communities showed a difference in peak expiratory flow rates, adjusted for age, sex and height, or in the incidence of acute respiratory symptoms over the 35-day recording period during the first year of study.

A chemical mass-balance analysis of particle sources during the period of the study estimated that a maximum of 3% of the particle mass in ambient air could be attributed to emissions from the biomedical-waste incinerator on days when the prevailing wind was blowing directly from the incinerator toward the air-monitoring station less than 1 km away. On days when the prevailing wind was in other directions, the contribution of the incinerator to the particle mass measured at the monitoring station was less than 1%. Shy et al. (1995) concluded that data from the first year of study were compatible with the null hypothesis of no difference in acute or chronic respiratory symptoms or lung function between paired target and comparison communities and that particle and acid-gas emissions from the three incinerators contributed trivial quantities to the ambient-air concentrations in the adjacent neighborhoods.

Thus, the few community-based epidemiologic studies reported to date have yielded no evidence that acute or chronic respiratory symptoms are associated with incinerator emissions. However, that conclusion is based on only two community studies, that of Gray et al. (1994) in Sydney, Australia, and that of Shy et al. (1995) in North Carolina. In both measures of air quality, specifically of particles and gases, showed no difference between the incinerator and comparison communities. The lack of difference in concentrations of commonly measured air pollutants found in these studies does not rule out the possibility of differences in concentrations of unmeasured pollutants of concern (such as PCDDs and PCDFs) that may be present in incinerator emissions as well as in background pollution. Thus, such measurements do not directly show that there can be no excess of respiratory effects due to incinerators. However, the absence of differences in the prevalence of asthma among exposed children in the Sydney study and the absence of differences in the incidence of acute respiratory symptoms or in lung function in the North Carolina study are at least suggestive that unmeasured pollutants from well controlled incinerators are not causing overt short-term effects on the respiratory system.

An excess of lung-function abnormalities was found in the schoolchildren study of Wang et al. (1992) in Taiwan, in which the target population had considerably higher measured concentrations of ambient SO2 and NO2. This supports the conclusion that if incinerator emissions result in violation of air-quality standards, the adverse health effects attributable to the excesses can be expected.

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