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He L, Evans S, Norris C, Barkjohn K, Cui X, Li Z, Zhou X, Li F, Zhang Y, Black M, Bergin MH, Zhang J(J. Associations between personal apparent temperature exposures and asthma symptoms in children with asthma. PLoS One 2023; 18:e0293603. [PMID: 37956155 PMCID: PMC10642815 DOI: 10.1371/journal.pone.0293603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/16/2023] [Indexed: 11/15/2023] Open
Abstract
Ambient temperature and relative humidity can affect asthma symptoms. Apparent temperature is a measure of temperature perceived by humans that takes into account the effect of humidity. However, the potential link between personal exposures to apparent temperature and asthma symptoms has not been investigated. We conducted a panel study of 37 asthmatic children, aged 5-11 years, during an early spring season (average daily ambient temperature: 14°C, range: 7-18°C). Asthma symptoms were measured 4 times for each participant with a 2-week interval between consecutive measurements using the Childhood Asthma-Control Test (C-ACT). Average, minimum, and maximum personal apparent temperature exposures, apparent temperature exposure variability (TV), and average ambient temperature were calculated for the 12 hours, 24 hours, week, and 2 weeks prior to each visit. We found that a 10°C lower in 1-week and 2-week average & minimum personal apparent temperature exposures, TV, and average ambient temperature exposures were significantly associated with lower total C-ACT scores by up to 2.2, 1.4, 3.3, and 1.4 points, respectively, indicating worsened asthma symptoms. Our results support that personal apparent temperature exposure is potentially a stronger driver than ambient temperature exposures for the variability in asthma symptom scores. Maintaining a proper personal apparent temperature exposure could be an effective strategy for personalized asthma management.
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Affiliation(s)
- Linchen He
- Department of Community and Population Health, College of Health, Lehigh University, Bethlehem, Pennsylvania, United States of America
| | - Shoshana Evans
- Department of Community and Population Health, College of Health, Lehigh University, Bethlehem, Pennsylvania, United States of America
| | - Christina Norris
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Karoline Barkjohn
- Department of Civil and Environmental Engineering, Duke University, Durham, North Carolina, United States of America
- Office of Research and Development, US Environmental Protection Agency, Research Triangle Park, North Carolina, United States of America
| | - Xiaoxing Cui
- Nicholas School of the Environment, Duke University, Durham, North Carolina, United States of America
| | - Zhen Li
- Department of Pediatrics, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaojian Zhou
- Department of Pediatrics, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Feng Li
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yinping Zhang
- Department of Building Science, Tsinghua University, Beijing, China
- Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Beijing, China
| | - Marilyn Black
- Underwriters Laboratories, Inc, Marietta, Georgia, United States of America
| | - Michael H. Bergin
- Department of Civil and Environmental Engineering, Duke University, Durham, North Carolina, United States of America
| | - Junfeng (Jim) Zhang
- Nicholas School of the Environment, Duke University, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Duke Kunshan University, Kunshan, Jiangsu Province, China
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Simunovic M, Boyle J, Erbas B, Baker P, Davies JM. Airborne grass pollen and thunderstorms influence emergency department asthma presentations in a subtropical climate. ENVIRONMENTAL RESEARCH 2023; 236:116754. [PMID: 37500047 DOI: 10.1016/j.envres.2023.116754] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/13/2023] [Accepted: 07/25/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Grass pollen is considered a major outdoor aeroallergen source worldwide. It is proposed as a mechanism for thunderstorm asthma that lightning during thunderstorms promotes electrical rupture of pollen grains that leads to allergic airway inflammation. However, most evidence of associations between grass pollen and asthma comes from temperate regions. The objective of this study was to investigate short-term associations between airborne grass pollen exposure and asthma emergency department presentations in a subtropical population. METHODS Episode level public hospital presentations for asthma (2016-2020) were extracted for greater Brisbane, Australia, from Queensland Health's Emergency Data Collection. Concentrations of airborne pollen were determined prospectively using a continuous flow volumetric impaction sampler. Daily time series analysis using a generalised additive mixed model were applied to determine associations between airborne grass pollen concentrations, and lightning count data, with asthma presentations. RESULTS Airborne grass pollen showed an association with asthma presentations in Brisbane; a significant association was detected from same day exposure to three days lag. Grass pollen exposure increased daily asthma presentations up to 48.5% (95% CI: 12%, 85.9%) in female children. Lightning did not modify the effect of grass pollen on asthma presentations, however a positive association was detected between cloud-to-cloud lightning strikes and asthma presentations (P = 0.048). CONCLUSION Airborne grass pollen exposure may exacerbate symptoms of asthma requiring urgent medical care of children and adults in a subtropical climate. This knowledge indicates an opportunity for targeted management of respiratory allergic disease to reduce patient and health system burden. For the first time, an influence of lightning on asthma was detected in this context. The outcomes support a need for continued pollen monitoring and surveillance of thunderstorm asthma risk in subtropical regions.
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Affiliation(s)
- Marko Simunovic
- School of Biomedical Sciences, Centre for Immunity and Infection Control, Centre for Environment, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Justin Boyle
- Australian E-Health Research Centre, The Commonwealth Scientific and Industrial Research Organisation, Brisbane, Queensland, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, LaTrobe University, Bundoora, Victoria, Australia
| | - Philip Baker
- School of Public Health and Social Work, Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Janet M Davies
- School of Biomedical Sciences, Centre for Immunity and Infection Control, Centre for Environment, Queensland University of Technology, Brisbane, Queensland, Australia; Office of Research, Metro North Hospital and Health Services, Herston, Queensland, Australia.
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Lappe BL, Ebelt S, D'Souza RR, Manangan A, Brown C, Saha S, Harris D, Chang HH, Sole A, Scovronick N. Pollen and asthma morbidity in Atlanta: A 26-year time-series study. ENVIRONMENT INTERNATIONAL 2023; 177:107998. [PMID: 37290290 PMCID: PMC10600739 DOI: 10.1016/j.envint.2023.107998] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/28/2023] [Accepted: 05/26/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Compared to many environmental risk factors, the relationship between pollen and asthma is understudied, including how associations may differ by pollen type and between subgroups, and how associations may be changing over time. OBJECTIVES We evaluated the association between ambient pollen concentrations and emergency department (ED) visits for asthma and wheeze in Atlanta, Georgia during 1993-2018. We estimated overall associations for 13 individual pollen taxa, as well as associations by decade, race, age (5-17, 18-64, 65+), and insurance status (Medicaid vs non-Medicaid). METHODS Speciated pollen data were acquired from Atlanta Allergy & Asthma, a nationally certified pollen counting station. ED visit data were obtained from individual hospitals and from the Georgia Hospital Association. We performed time-series analyses using quasi-Poisson distributed lag models, with primary analyses assessing 3-day (lag 0-2 days) pollen levels. Models controlled for day of week, holidays, air temperature, month, year, and month-by-year interactions. RESULTS From 1993 to 2018, there were 686,259 ED visits for asthma and wheeze in the dataset, and the number of ED visits increased over time. We observed positive associations of asthma and wheeze ED visits with nine of the 13 pollen taxa: trees (maple, birch, pine, oak, willow, sycamore, and mulberry), two weeds (nettle and pigweed), and grasses. Rate ratios indicated 1-8% increases in asthma and wheeze ED visits per standard deviation increases in pollen. In general, we observed stronger associations in the earliest period (1993-2000), in younger people, and in Black patients; however, results varied by pollen taxa. CONCLUSIONS Some, but not all, types of pollen are associated with increased ED visits for asthma/wheeze. Associations are generally higher in Black and younger patients and appear to have decreased over time.
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Affiliation(s)
- Brooke L Lappe
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Stefanie Ebelt
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Rohan R D'Souza
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Arie Manangan
- Climate and Health Program, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Claudia Brown
- Climate and Health Program, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shubhayu Saha
- Climate and Health Program, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA; Office of Climate Change and Health Equity, Department of Health and Human Services, Washington DC, USA
| | - Drew Harris
- Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, VA, USA
| | - Howard H Chang
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Adam Sole
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Noah Scovronick
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Lockdown Fatigue in Pediatric Respiratory Patients: Lessons from the First COVID-19 Year. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121862. [PMID: 36553306 PMCID: PMC9776677 DOI: 10.3390/children9121862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/25/2022] [Accepted: 11/27/2022] [Indexed: 12/02/2022]
Abstract
Lockdown policies have been implemented worldwide to limit the spread of COVID-19. “Lockdown fatigue” is a state of exhaustion related to the accumulating effects of repeated lockdowns. The aim of the current study was to examine the effects of repeated lockdowns on children with respiratory disorders. Data on children aged 0−18 years old with respiratory disorders were collected by an electronic survey during the third lockdown in Israel. The retrieved information included demographics and baseline medical status, respiratory clinical status during the third lockdown compared to pre-lockdown periods, lockdown adherence, lifestyle modifications and caregiver emotional status. The results were compared to those of a similar questionnaire distributed during the first lockdown. A total of 234 patients (62% males, 37% females, mean age 6.8 years (confidence interval 6.1−7.5)) were enrolled. Respiratory symptoms and exacerbation frequency were reduced in 76 (35.5%) and 58 (27.4%) patients, respectively, compared to the pre-lockdown period and similar to the first lockdown (p = 0.840 and p = 0.063, respectively). However, compared to the first lockdown, the third lockdown was associated with greater use of reliever medications (p = 0.006), less use of inhaled corticosteroids as routine treatment (p = 0.027), and more pediatric emergency room visits and hospitalizations (p = 0.001 and p < 0.001, respectively). The results also showed an increase in sedentary lifestyle (e.g., reduced physical activity (p = 0.025), less healthy eating habits (p = 0.001)) and reduced adherence to lockdown policies (p < 0.001). These data show that the continuing stability of clinical improvement during lockdown was accompanied by deleterious sequelae that potentially indicate “lockdown fatigue” among children with respiratory disorders.
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Bloom CI, Franklin C, Bush A, Saglani S, Quint JK. Burden of preschool wheeze and progression to asthma in the UK: Population-based cohort 2007 to 2017. J Allergy Clin Immunol 2021; 147:1949-1958. [PMID: 33453287 DOI: 10.1016/j.jaci.2020.12.643] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Wheeze is one of the most common symptoms of preschool children (age 1-5 years), yet we have little understanding of the burden in the United Kingdom. OBJECTIVES We sought to determine prevalence and pattern of physician-confirmed preschool wheeze, related health care utilization, and factors associated with progression to school-age asthma. METHODS We used nationally representative primary and secondary care electronic medical records between 2007 and 2017 to identify preschool children with wheeze. Factors associated with asthma progression were identified in a nested cohort of children with follow-up from age 1 to 2 years, until at least age 8 years. RESULTS From 1,021,624 preschool children, 69,261 were identified with wheeze. Prevalence of preschool wheeze was 7.7% in 2017. Wheeze events were lowest in August and highest in late-autumn/early-winter. During median follow-up of 2 years (interquartile range, 1.2-4.0 years), 15.8% attended an emergency department, and 13.9% had a hospital admission, for a respiratory disorder. The nested cohort with prolonged follow-up identified 15,085 children; 35.5% progressed to asthma between age 5 and 8 years. Of children with preschool wheeze, without an asthma diagnosis, 34.9% were prescribed inhaled corticosteroids and 15.6% oral corticosteroids. The factors most strongly associated with progression to asthma were wheeze frequency and severity, atopy, prematurity, maternal asthma severity, and first reported wheeze event occurring in September. CONCLUSIONS Preschool wheeze causes considerable health care burden, and a large number of children are prescribed asthma medication and have unplanned secondary care visits. Multiple factors influence progression to asthma, including first wheeze event occurring in September.
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Affiliation(s)
- Chloe I Bloom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.
| | - Courtney Franklin
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Andrew Bush
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Sejal Saglani
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
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Ma R, Liang L, Kong Y, Zhai S, Gu J, Zhang G, Wang T. Hotspot detection and socio-ecological factor analysis of asthma hospitalization rate in Guangxi, China. ENVIRONMENTAL RESEARCH 2020; 183:109201. [PMID: 32050128 DOI: 10.1016/j.envres.2020.109201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/15/2020] [Accepted: 01/29/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Asthma is a major public health concern throughout the world. Numerous researches have shown that the spatial-temporal patterns of asthma are inconsistent, leading to the suggestion that these patterns are determined by multiple factors. This study aims to detect spatial-temporal clusters of asthma and analyze socio-ecological factors associated with the asthma hospitalization rate in Guangxi, China. METHODS Asthma hospitalization and socio-ecological data for 88 counties/municipal districts in Guangxi, China in 2015 was collected. Space-time scan statistics were applied to identify the high-risk periods and areas of asthma hospital admissions. We further used GeoDetector and Spearman correlation coefficient to investigate the socio-ecological factors associated with the asthma hospitalization rates. RESULTS There were a total of 7804 asthma admissions in 2015. The high-risk period was from April to June. The age groups of 0-4 and ≥65 years were both at the highest risk, with hospital admission rates of 45.0/105 and 46.5/105, respectively. High-risk areas were found in central and western Guangxi with relative risk (RR) values of asthma hospitalizations greater than 2.0. GDP per capita and altitude were positively associated with asthma hospitalizations, while air pressure and wind speed had a negative association. The explanatory powers of these factors (i.e., GDP per capita, altitude, air pressure, wind speed) were 22%, 20%, 14% and 10%, respectively. CONCLUSIONS The GDP per capita appears to have the strongest correlation with asthma hospitalization rates. High-risk areas were identified in central and western Guangxi characterized by high GDP per capita. These findings may be helpful for authorities developing targeted asthma prevention policies for high-risk areas and vulnerable populations, especially during high-risk periods.
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Affiliation(s)
- Rui Ma
- Key Laboratory of Geospatial Technology for the Middle and Lower Yellow River Regions, Ministry of Education, Henan University, Kaifeng, 475004, China.
| | - Lizhong Liang
- The Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, China.
| | - Yunfeng Kong
- Key Laboratory of Geospatial Technology for the Middle and Lower Yellow River Regions, Ministry of Education, Henan University, Kaifeng, 475004, China.
| | - Shiyan Zhai
- Key Laboratory of Geospatial Technology for the Middle and Lower Yellow River Regions, Ministry of Education, Henan University, Kaifeng, 475004, China.
| | - Jiangyan Gu
- Key Laboratory of Geospatial Technology for the Middle and Lower Yellow River Regions, Ministry of Education, Henan University, Kaifeng, 475004, China.
| | - Guangli Zhang
- Key Laboratory of Geospatial Technology for the Middle and Lower Yellow River Regions, Ministry of Education, Henan University, Kaifeng, 475004, China.
| | - Tuanhui Wang
- Key Laboratory of Geospatial Technology for the Middle and Lower Yellow River Regions, Ministry of Education, Henan University, Kaifeng, 475004, China.
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Simunovic M, Dwarakanath D, Addison-Smith B, Susanto NH, Erbas B, Baker P, Davies JM. Grass pollen as a trigger of emergency department presentations and hospital admissions for respiratory conditions in the subtropics: A systematic review. ENVIRONMENTAL RESEARCH 2020; 182:109125. [PMID: 32069762 DOI: 10.1016/j.envres.2020.109125] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/11/2019] [Accepted: 01/06/2020] [Indexed: 06/10/2023]
Abstract
INTRODUCTION It is unknown if high concentration of airborne grass pollen, where subtropical grasses (Chloridoideae and Panicoideae) dominate, is a risk factor for respiratory health. Here we systematically reviewed the association between airborne grass pollen exposure and asthma emergency department (ED) presentations and hospital admissions in subtropical climates. OBJECTIVES A systematic review was performed to identify and summarise studies that reported on respiratory health (asthma ED presentations and hospital admissions) and airborne grass pollen exposure in subtropical climates. METHODS Searches were conducted in: MEDLINE, Web of Science, Scopus, CINAHL (EBSCO), Embase and Google Scholar databases (1966-2019). Risk of bias was assessed using a validated quality assessment tool. A meta-analysis was planned, however due to the heterogeneity in study design it was determined inappropriate and instead a narrative synthesis was undertaken. RESULTS Nineteen studies were identified for inclusion, with a total of 598,931 asthma ED presentation participants and 36,504 asthma hospital admission participants in six countries (Australia, India, Israel, Italy, Spain, USA). The narrative synthesis found airborne grass pollen appears to have a small and inconsistent increase on asthma ED presentations (judged as: probably little effect n = 5, may have little effect n = 4, no effect n = 2 and uncertain if there is an effect n = 4) and hospital admissions (judged as: probably increase slightly n = 2 probably little effect n = 1, may have a little effect n = 1, no effect n = 3 and we are uncertain if there is an effect n = 4) in the subtropics. Furthermore, the reported effect sizes were small and its clinical relevance may be difficult to discern. CONCLUSION Exposure to airborne grass pollen appears to have a small and inconsistent increase on asthma ED presentations and hospital admissions in the subtropics. These findings are comparable to reported observations from studies undertaken in temperate regions.
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Affiliation(s)
- Marko Simunovic
- School of Biomedical Sciences, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Divya Dwarakanath
- School of Biomedical Sciences, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Beth Addison-Smith
- School of Biomedical Sciences, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Nugroho H Susanto
- School of Public Health and Epidemiology, LaTrobe University, Bundoora, Victoria, Australia
| | - Bircan Erbas
- School of Public Health and Epidemiology, LaTrobe University, Bundoora, Victoria, Australia
| | - Philip Baker
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Janet M Davies
- School of Biomedical Sciences, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia; Office of Research, Metro North Hospital and Health Services,Herston, Queensland, Australia
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Witonsky J, Abraham R, Toh J, Desai T, Shum M, Rosenstreich D, Jariwala SP. The association of environmental, meteorological, and pollen count variables with asthma-related emergency department visits and hospitalizations in the Bronx. J Asthma 2018; 56:927-937. [PMID: 30207818 DOI: 10.1080/02770903.2018.1514627] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: To better understand how meteorological variables, air quality variables, and pollen counts collectively contribute to asthma-related emergency department visits (AREDV) and asthma-related hospitalizations (ARH) among pediatric and adult patients in the New York City borough of the Bronx. Methods: The numbers of daily adult and pediatric AREDV and ARH from 2001 to 2008 were obtained from three Bronx hospitals. After removing outliers, interpolating missing data, and standardizing variable values by scaling the data using z-scores, data were analyzed using Spearman rank tests and linear regression models for the full year and each season. Results: There were a total of 42,065 AREDV and 1,664 ARH at both Bronx hospitals. With the exception of a spring peak in AREDVs, AREDVs and ARHs follow a cyclical pattern, climbing in the fall, plateauing in the winter, dropping in the spring, and reaching a low in the summer. Among the 11 air quality, meteorological, and pollen count variables, temperature and tree pollen made the greatest contribution to AREDV with scaled coefficients of -0.337 and 0.311 respectively; equating to an additional AREDV for every 5.0-unit decrease in temperature and an additional AREDV for every 186.0-unit increase in tree pollen. These two variables were confirmed to have independent associations with AREDV prior to the data interpolation. Grass pollen was also found to have a relatively large contribution to AREDV during the summer with a scaled coefficient of 0.314, equating to an additional AREDV for every 2.3-unit increase in grass pollen. Conclusion: There are distinct peaks of increased AREDVs that are closely associated with increased tree pollen counts in the spring and decreasing temperatures in the fall. Early anticipation of these air quality, meteorological, and pollen factor changes based on ongoing surveillance could potentially guide clinical practice and minimize AREDVs in the Bronx.
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Affiliation(s)
- Jonathan Witonsky
- a Department of Pediatrics, University of California , San Francisco , CA , USA ; Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ryan Abraham
- b Division of Allergy/Immunology, Albert Einstein College of Medicine ; Bronx , NY , USA
| | - Jennifer Toh
- b Division of Allergy/Immunology, Albert Einstein College of Medicine ; Bronx , NY , USA
| | - Tulsi Desai
- b Division of Allergy/Immunology, Albert Einstein College of Medicine ; Bronx , NY , USA
| | - Mili Shum
- b Division of Allergy/Immunology, Albert Einstein College of Medicine ; Bronx , NY , USA
| | - David Rosenstreich
- b Division of Allergy/Immunology, Albert Einstein College of Medicine ; Bronx , NY , USA
| | - Sunit P Jariwala
- b Division of Allergy/Immunology, Albert Einstein College of Medicine ; Bronx , NY , USA
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Martínez-Rivera C, Garcia-Olivé I, Stojanovic Z, Radua J, Ruiz Manzano J, Abad-Capa J. Association between air pollution and asthma exacerbations in Badalona, Barcelona (Spain), 2008-2016. Med Clin (Barc) 2018; 152:333-338. [PMID: 30149947 DOI: 10.1016/j.medcli.2018.06.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/18/2018] [Accepted: 06/21/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND OBJECTIVE Air pollution has been widely associated with respiratory diseases. Nevertheless, association between air pollution and exacerbations of asthma in our area has been less studied. To analyse the effect of air pollution on exacerbations of asthma in Badalona. MATERIAL AND METHODS This was an observational study conducted in Badalona. The number of daily hospital admissions and accident and emergency visits related to exacerbation of asthma between 2008 and 2016 was obtained. We used simple Poisson regressions to test the effects of daily mean temperature, atmospheric pressure, relative humidity, and NO2, SO2 and CO levels on asthma-related emergencies and hospitalisations the same day and 1-4 days after. All p-values were corrected for multiple comparisons. RESULTS The number of hospitalisations was associated with low temperature (lags 0 to 4) and higher levels of NO2 (lags 0, 1, 2 and 4) and atmospheric pressure (lags 2 and 3). The number of accident and emergency visits was associated with low temperature (lags 0 to 4) and higher levels of NO2 (lags 2, 3 and 4). CONCLUSIONS The number of accident and emergency visits and hospitalisations for exacerbation of asthma is associated with higher levels of NO2 and with lower temperatures.
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Affiliation(s)
- Carlos Martínez-Rivera
- Servicio de Neumología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, España; Ciber de Enfermedades Respiratorias (CibeRes), Bunyola, Mallorca, España
| | - Ignasi Garcia-Olivé
- Servicio de Neumología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, España; Departament de Medicina, Universitat Autònoma de Barcelona, Bellatera, Barcelona, España; Ciber de Enfermedades Respiratorias (CibeRes), Bunyola, Mallorca, España.
| | - Zoran Stojanovic
- Servicio de Neumología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España; Departament de Medicina, Universitat Autònoma de Barcelona, Bellatera, Barcelona, España; Ciber de Enfermedades Respiratorias (CibeRes), Bunyola, Mallorca, España
| | - Joaquim Radua
- Department of Statistics, FIDMAG Research Unit, Sant Boi de Llobregat, Barcelona, España; Ciber de Salud Mental (CiberSam), Madrid, España; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Estocolmo, Suecia; Ciber de Enfermedades Respiratorias (CibeRes), Bunyola, Mallorca, España
| | - Juan Ruiz Manzano
- Servicio de Neumología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, España; Departament de Medicina, Universitat Autònoma de Barcelona, Bellatera, Barcelona, España; Ciber de Enfermedades Respiratorias (CibeRes), Bunyola, Mallorca, España
| | - Jorge Abad-Capa
- Servicio de Neumología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, España; Departament de Medicina, Universitat Autònoma de Barcelona, Bellatera, Barcelona, España; Ciber de Enfermedades Respiratorias (CibeRes), Bunyola, Mallorca, España
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Erbas B, Jazayeri M, Lambert KA, Katelaris CH, Prendergast LA, Tham R, Parrodi MJ, Davies J, Newbigin E, Abramson MJ, Dharmage S. Outdoor pollen is a trigger of child and adolescent asthma emergency department presentations: A systematic review and meta-analysis. Allergy 2018; 73:1632-1641. [PMID: 29331087 DOI: 10.1111/all.13407] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND In the context of increased asthma exacerbations associated with climatic changes such as thunderstorm asthma, interest in establishing the link between pollen exposure and asthma hospital admissions has intensified. Here, we systematically reviewed and performed a meta-analysis of studies on pollen and emergency department (ED) attendance. METHODS A search for studies with appropriate search strategy in MEDLINE, EMBASE, Web of Science and CINAHL was conducted. Each study was assessed for quality and risk of bias. The available evidence was summarized both qualitatively and meta-analysed using random-effects models when moderate heterogeneity was observed. RESULTS Fourteen studies were included. The pollen taxa investigated differed between studies, allowing meta-analysis only of the effect of grass pollen. A statistically significant increase in the percentage change in the mean number of asthma ED presentations (MPC) (pooled results from 3 studies) was observed for an increase in 10 grass pollen grains per cubic metre of exposure 1.88% (95% CI = 0.94%, 2.82%). Time series studies showed positive correlations between pollen concentrations and ED presentations. Age-stratified studies found strongest associations in children aged 5-17 years old. CONCLUSION Exposure to ambient grass pollen is an important trigger for childhood asthma exacerbations requiring ED attendance. As pollen exposure is increasingly a problem especially in relation to thunderstorm asthma, studies with uniform measures of pollen and similar analytical methods are necessary to fully understand its impact on human health.
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Affiliation(s)
- B. Erbas
- School of Psychology and Public Health; La Trobe University; Bundoora Vic. Australia
| | - M. Jazayeri
- Department of Mathematics and Statistics; La Trobe University; Bundoora Vic. Australia
| | - K. A. Lambert
- School of Psychology and Public Health; La Trobe University; Bundoora Vic. Australia
| | - C. H. Katelaris
- Department of Medicine, Immunology and Allergy; Campbelltown Hospital; Western Sydney University; Campbelltown NSW Australia
| | - L. A. Prendergast
- Department of Mathematics and Statistics; La Trobe University; Bundoora Vic. Australia
| | - R. Tham
- Allergy and Lung Health Unit; Melbourne School of Population and Global Health; University of Melbourne; Melbourne Vic. Australia
| | - M. J. Parrodi
- School of Psychology and Public Health; La Trobe University; Bundoora Vic. Australia
| | - J. Davies
- Institute of Health and Biomedical Innovation; Queensland University of Technology; South Brisbane Qld Australia
| | - E. Newbigin
- School of Biosciences; University of Melbourne; Melbourne Vic. Australia
| | - M. J. Abramson
- Department of Epidemiology and Preventive Medicine; School of Public Health and Preventive Medicine; Monash University; Melbourne Vic. Australia
| | - S. C. Dharmage
- Allergy and Lung Health Unit; Melbourne School of Population and Global Health; University of Melbourne; Melbourne Vic. Australia
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12
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Osborne NJ, Alcock I, Wheeler BW, Hajat S, Sarran C, Clewlow Y, McInnes RN, Hemming D, White M, Vardoulakis S, Fleming LE. Pollen exposure and hospitalization due to asthma exacerbations: daily time series in a European city. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2017; 61:1837-1848. [PMID: 28500390 PMCID: PMC5643363 DOI: 10.1007/s00484-017-1369-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 04/17/2017] [Accepted: 04/27/2017] [Indexed: 05/03/2023]
Abstract
Exposure to pollen can contribute to increased hospital admissions for asthma exacerbation. This study applied an ecological time series analysis to examine associations between atmospheric concentrations of different pollen types and the risk of hospitalization for asthma in London from 2005 to 2011. The analysis examined short-term associations between daily pollen counts and hospital admissions in the presence of seasonal and long-term patterns, and allowed for time lags between exposure and admission. Models were adjusted for temperature, precipitation, humidity, day of week, and air pollutants. Analyses revealed an association between daily counts (continuous) of grass pollen and adult hospital admissions for asthma in London, with a 4-5-day lag. When grass pollen concentrations were categorized into Met Office pollen 'alert' levels, 'very high' days (vs. 'low') were associated with increased admissions 2-5 days later, peaking at an incidence rate ratio of 1.46 (95%, CI 1.20-1.78) at 3 days. Increased admissions were also associated with 'high' versus 'low' pollen days at a 3-day lag. Results from tree pollen models were inconclusive and likely to have been affected by the shorter pollen seasons and consequent limited number of observation days with higher tree pollen concentrations. Future reductions in asthma hospitalizations may be achieved by better understanding of environmental risks, informing improved alert systems and supporting patients to take preventive measures.
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Affiliation(s)
- Nicholas J Osborne
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK.
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Ian Alcock
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK
| | - Benedict W Wheeler
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK
| | - Shakoor Hajat
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Rachel N McInnes
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK
- Met Office Hadley Centre, Fitzroy Road, Exeter, EX1 3PB, UK
| | | | - Mathew White
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK
| | - Sotiris Vardoulakis
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK
- London School of Hygiene and Tropical Medicine, London, UK
- Environmental Change Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, Oxon, OX11 0RQ, UK
| | - Lora E Fleming
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK
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13
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Turi KN, Gebretsadik T, Lee RL, Hartert TV, Evans AM, Stone C, Sicignano NM, Wu AC, Iribarren C, Butler MG, Mitchel E, Morrow J, Larkin EK, Wu P. Seasonal patterns of Asthma medication fills among diverse populations of the United States. J Asthma 2017; 55:764-770. [PMID: 28881155 DOI: 10.1080/02770903.2017.1362426] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Nonadherence to controller and overuse of reliever asthma medications are associated with exacerbations. We aimed to determine patterns of seasonal asthma medication use and to identify time period(s) during which interventions to improve medication adherence could reduce asthma morbidity. METHODS We conducted a retrospective cohort study of asthmatics 4-50 years of age and enrolled in three diverse health insurance plans. Seasonal patterns of medications were reported by monthly prescription fill rates per 1000 individuals with asthma from 1998 to 2013, and stratified by healthcare plan, sex, and age. RESULTS There was a distinct and consistent seasonal fill pattern for all asthma medications. The lowest fill rate was observed in the month of July. Fills increased in the autumn and remained high throughout the winter and spring. Compared with the month of May with high medication fills, July represented a relative decrease of fills ranging from 13% (rate ratio, RR: 0.87, 95% confidence interval, 95%CI: 0.72-1.04) for the combination of inhaled corticosteroids (ICS) + long acting beta agonists (LABA) to 45% (RR: 0.55, 95%CI: 0.49-0.61) for oral corticosteroids. Such a seasonal pattern was observed each year across the 16-year study period, among healthcare plans, sexes, and ages. LABA containing control medication (ICS+LABA and LABA) fill rates were more prevalent in older asthmatics, while leukotriene receptor antagonists were more prevalent in the younger population. CONCLUSIONS A seasonal pattern of asthma medication fill rates likely represents a reactive response to a loss of disease control and increased symptoms. Adherence to and consistent use of asthma medications among individuals who use medications in reaction to seasonal exacerbations might be a key component in reducing the risk of asthma exacerbations.
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Affiliation(s)
- Kedir N Turi
- a Department of Medicine , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Tebeb Gebretsadik
- b Department of Biostatistics , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Rees L Lee
- c Naval Medical Research Unit Dayton , Wright Patterson AFB , OH , USA
| | - Tina V Hartert
- a Department of Medicine , Vanderbilt University Medical Center , Nashville , TN , USA
| | | | - Cosby Stone
- a Department of Medicine , Vanderbilt University Medical Center , Nashville , TN , USA
| | | | - Ann C Wu
- e Department of Population Medicine , Harvard Medical School and Harvard Pilgrim Health Care , Boston , MA , USA
| | - Carlos Iribarren
- f Division of Research , Kaiser Permanente Northern California , Oakland , CA , USA
| | - Melissa G Butler
- g Center for Clinical and Outcomes Research , Kaiser Permanente Georgia , Atlanta , GA , USA.,h Roivant Sciences Ltd. , Hamilton , Bermuda
| | - Edward Mitchel
- i Department of Health Policy , Vanderbilt University Medical Center , Nashville , TN , USA
| | - James Morrow
- i Department of Health Policy , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Emma K Larkin
- a Department of Medicine , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Pingsheng Wu
- a Department of Medicine , Vanderbilt University Medical Center , Nashville , TN , USA.,b Department of Biostatistics , Vanderbilt University Medical Center , Nashville , TN , USA
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14
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Tham R, Katelaris CH, Vicendese D, Dharmage SC, Lowe AJ, Bowatte G, Taylor P, Burton P, Abramson MJ, Erbas B. The role of outdoor fungi on asthma hospital admissions in children and adolescents: A 5-year time stratified case-crossover analysis. ENVIRONMENTAL RESEARCH 2017; 154:42-49. [PMID: 28024227 DOI: 10.1016/j.envres.2016.12.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 11/16/2016] [Accepted: 12/18/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Some fungal spores can trigger asthma exacerbation but knowledge of which outdoor fungal spores contribute to asthma hospitalisation is limited. OBJECTIVES To examine the role of outdoor fungal spores in child and adolescent asthma hospitalisations. METHODS We conducted a bi-directional time-stratified case-crossover study of child and adolescent asthma hospitalisations over 5 years. Conditional logistic regression assessed the role of 20 fungi taxa (Same day [L0] and lagged [L1-3]) adjusted for maximum temperature, humidity and grass pollen. Strata specific effects were explored if there was evidence of effect modification by age, sex, air pollutants or grass pollen. Non-linear effects examined with Generalized Additive Models. RESULTS Of 2098 children hospitalised for asthma, 60% were boys; mean age was 5.5±3.7 years. Fungal spore counts peaked during warm months. Regression models found weak associations with Coprinus [L0,L1: OR=1.03, 1.01-1.06], Periconia [L0: OR=1.03, 1.001-1.07] and Chaetomium [L2: OR=1.08, 1.0-1.2]. Sex appeared to act as an effect modifier with girls having stronger associations with Cladosporium, Coprinus and total fungi. Older adolescent (14-18 years) hospitalisation was significantly associated with Coprinus and Ustilago/smuts. Air pollutants and grass pollen did not appear to act as effect modifiers. Non-linearity was not detected. CONCLUSION There may be associations between some outdoor fungal spores and asthma hospitalisations. Further research needed to explore whether these findings can be replicated; and examine whether fungal sensitisation and/or human rhinovirus infections are associated with stronger effects. If findings are replicated, then the need to develop predictive models for fungal spore distribution and levels may become more important.
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Affiliation(s)
- Rachel Tham
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
| | - Constance H Katelaris
- Western Sydney University, Department of Medicine, Immunology and Allergy, Campbelltown Hospital, Campbelltown, New South Wales, Australia.
| | - Don Vicendese
- School of Public Health, College of Science Health and Engineering, La Trobe University, Bundoora, Victoria, Australia.
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
| | - Adrian J Lowe
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
| | - Gayan Bowatte
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
| | - Philip Taylor
- School of Life and Environmental Sciences, Deakin University, Geelong, Victoria, Australia.
| | - Pamela Burton
- Western Sydney University, Department of Medicine, Immunology and Allergy, Campbelltown Hospital, Campbelltown, New South Wales, Australia.
| | - Michael J Abramson
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Bircan Erbas
- School of Public Health, College of Science Health and Engineering, La Trobe University, Bundoora, Victoria, Australia.
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15
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Yun HS, Rah WJ, Choi YJ, Kim JH, Oh JW, Kim HH, Chang YS, Yoo KH, Sohn KT. The development of patient-tailored asthma prediction model for the alarm system. ALLERGY ASTHMA & RESPIRATORY DISEASE 2016. [DOI: 10.4168/aard.2016.4.5.328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Hey-Suk Yun
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Wee Jin Rah
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Young Jin Choi
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Joo-Hwa Kim
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Jae-Won Oh
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Hyun-Hee Kim
- Department of Pediatrics, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, Korea
| | - Yoon-Seok Chang
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kwang-Ha Yoo
- School of Medicine, Konkuk University, Seoul, Korea
| | - Keon-Tae Sohn
- Department of Statistics, Pusan National University, Busan, Korea
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16
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Makra L, Puskás J, Matyasovszky I, Csépe Z, Lelovics E, Bálint B, Tusnády G. Weather elements, chemical air pollutants and airborne pollen influencing asthma emergency room visits in Szeged, Hungary: performance of two objective weather classifications. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2015; 59:1269-89. [PMID: 25504051 DOI: 10.1007/s00484-014-0938-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 11/16/2014] [Accepted: 11/16/2014] [Indexed: 05/19/2023]
Abstract
Weather classification approaches may be useful tools in modelling the occurrence of respiratory diseases. The aim of the study is to compare the performance of an objectively defined weather classification and the Spatial Synoptic Classification (SSC) in classifying emergency department (ED) visits for acute asthma depending from weather, air pollutants, and airborne pollen variables for Szeged, Hungary, for the 9-year period 1999-2007. The research is performed for three different pollen-related periods of the year and the annual data set. According to age and gender, nine patient categories, eight meteorological variables, seven chemical air pollutants, and two pollen categories were used. In general, partly dry and cold air and partly warm and humid air aggravate substantially the symptoms of asthmatics. Our major findings are consistent with this establishment. Namely, for the objectively defined weather types favourable conditions for asthma ER visits occur when an anticyclonic ridge weather situation happens with near extreme temperature and humidity parameters. Accordingly, the SSC weather types facilitate aggravating asthmatic conditions if warm or cool weather occur with high humidity in both cases. Favourable conditions for asthma attacks are confirmed in the extreme seasons when atmospheric stability contributes to enrichment of air pollutants. The total efficiency of the two classification approaches is similar in spite of the fact that the methodology for derivation of the individual types within the two classification approaches is completely different.
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Affiliation(s)
- László Makra
- Department of Climatology and Landscape Ecology, University of Szeged, 6701, Szeged, P.O.B. 653, Hungary,
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17
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Hervás D, Utrera JF, Hervás-Masip J, Hervás JA, García-Marcos L. Can meteorological factors forecast asthma exacerbation in a paediatric population? Allergol Immunopathol (Madr) 2015; 43:32-6. [PMID: 24168972 DOI: 10.1016/j.aller.2013.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 07/06/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Asthma exacerbations attended in emergency departments show a marked seasonality in the paediatric age. This seasonal pattern can change from one population to another and the factors involved are poorly understood. OBJECTIVES To evaluate the association between meteorological factors and schooling with asthma exacerbations in children attended in the paediatric emergency department of a district hospital. METHODS We conducted a retrospective review of the medical records of children 5-14 years of age attended for asthma exacerbations during a 4-year period (2007-2011). Climatic data were obtained from a weather station located very close to the population studied. The number of asthma exacerbations was correlated to temperature, barometric pressure, relative humidity, rainfall, wind speed, wind distance, solar radiation, water vapour pressure and schooling, using regression analyses. RESULTS During the study period, 371 children were attended for asthma exacerbations; median age was eight years (IQR: 6-11), and 59% were males. Asthma exacerbations showed a bimodal pattern with peaks in spring and summer. Maximum annual peak occurred in week 39, within 15 days from school beginning after the summer holidays. A regression model with mean temperature, water vapour pressure, relative humidity, maximum wind speed and schooling could explain 98.4% (p<0.001) of monthly asthma exacerbations. CONCLUSIONS The combination of meteorological factors and schooling could predict asthma exacerbations in children attended in a paediatric emergency department.
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Affiliation(s)
- D Hervás
- University Institute of Health Sciences-IUNICS, University of the Balearic Islands, Spain; Department of Paediatrics, Inca Hospital, Mallorca Spain.
| | - J F Utrera
- Department of Paediatrics, Inca Hospital, Mallorca Spain
| | - J Hervás-Masip
- University Institute of Health Sciences-IUNICS, University of the Balearic Islands, Spain
| | - J A Hervás
- University Institute of Health Sciences-IUNICS, University of the Balearic Islands, Spain
| | - L García-Marcos
- Respiratory Medicine and Allergy Units, Virgen de la Arrixaca University Children's Hospital, University of Murcia, Spain
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18
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Tham R, Dharmage SC, Taylor PE, Katelaris CH, Vicendese D, Abramson MJ, Erbas B. Outdoor fungi and child asthma health service attendances. Pediatr Allergy Immunol 2014; 25:439-49. [PMID: 24902620 DOI: 10.1111/pai.12257] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2014] [Indexed: 11/27/2022]
Abstract
Asthma is a significant global public health issue. Severe asthma exacerbations can be triggered by environmental factors and require medical care from health services. Although it is known that fungal exposure may lead to allergic sensitization, little is understood about its impact on asthma exacerbations. This review aims to examine whether outdoor fungi play a significant role in child asthma exacerbations. Systematic search of seven electronic databases and hand searching for peer-reviewed studies published in English, up to 31 August 2013. Inclusion criteria were study population aged <18 yr, diagnosis of asthma, attended a health service; outdoor fungi exposure was reported. Quality and risk of bias assessments were conducted. Due to significant heterogeneity, meta-analysis was not conducted. Of the 1896 articles found, 15 were eligible. Findings were not consistent, possibly due to methodological variations in exposure classifications, statistical methods and inclusion of confounders. Cross-sectional studies found no or weak associations. All but one time series studies indicated an association that varied between fungal species. Increasing evidence indicates that asthmatic children are susceptible to asthma exacerbations when exposed to outdoor fungal spores. There is limited understanding of the contributions of different fungal species. Research is needed to investigate interactions of outdoor fungi with pollen, air pollutants and respiratory viruses.
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Affiliation(s)
- Rachel Tham
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic., Australia
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19
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Cai J, Zhao A, Zhao J, Chen R, Wang W, Ha S, Xu X, Kan H. Acute effects of air pollution on asthma hospitalization in Shanghai, China. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2014; 191:139-44. [PMID: 24836410 DOI: 10.1016/j.envpol.2014.04.028] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 04/22/2014] [Accepted: 04/24/2014] [Indexed: 05/24/2023]
Abstract
Air pollution has been accepted as an important contributor to asthma development and exacerbation. However, the evidence is limited in China. In this study, we investigated the acute effect of air pollution on asthma hospitalization in Shanghai, China. We applied over-dispersed generalized additive model adjusted for weather conditions, day of the week, long-term and seasonal trends. An interquartile range increase in the moving average concentrations of PM10, SO2, NO2 and BC on the concurrent day and previous day corresponded to 1.82%, 6.41%, 8.26% and 6.62% increase of asthmatic hospitalization, respectively. The effects of SO2 and NO2 were robust after adjustment for PM10. The associations appeared to be more evident in the cool season than in the warm season. Our results contribute to the limited data in the scientific literature on acute effects of air pollution on asthma in high exposure settings, which are typical in developing countries.
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Affiliation(s)
- Jing Cai
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, China
| | - Ang Zhao
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, China
| | - Jinzhuo Zhao
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, China
| | - Renjie Chen
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, China; Research Institute for the Changing Global Environment and Fudan Tyndall Centre, Fudan University, Shanghai, China; Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP(3)), Fudan University, 130 Dong-An Road, Shanghai 200433, China
| | - Weibing Wang
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, China
| | - Sandie Ha
- Department of Epidemiology, College of Public Health and Health Professional and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Xiaohui Xu
- Department of Epidemiology, College of Public Health and Health Professional and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Haidong Kan
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, China; Research Institute for the Changing Global Environment and Fudan Tyndall Centre, Fudan University, Shanghai, China; Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP(3)), Fudan University, 130 Dong-An Road, Shanghai 200433, China.
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20
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Walford HH, Doherty TA. Diagnosis and management of eosinophilic asthma: a US perspective. J Asthma Allergy 2014; 7:53-65. [PMID: 24748808 PMCID: PMC3990389 DOI: 10.2147/jaa.s39119] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Eosinophilic asthma is now recognized as an important subphenotype of asthma based on the pattern of inflammatory cellular infiltrate in the airway. Eosinophilic asthma can be associated with increased asthma severity, atopy, late-onset disease, and steroid refractoriness. Induced sputum cell count is the gold standard for identifying eosinophilic inflammation in asthma although several noninvasive biomarkers, including fractional exhaled nitric oxide and periostin, are emerging as potential surrogates. As novel therapies and biologic agents become increasingly available, there is an increased need for specific phenotype-directed treatment strategies. Greater recognition and understanding of the unique immunopathology of this asthma phenotype has important implications for management of the disease and the potential to improve patient outcomes. The present review provides a summary of the clinical features, pathogenesis, diagnosis, and management of eosinophilic asthma.
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Affiliation(s)
- Hannah H Walford
- Department of Medicine, University of California, La Jolla, CA, USA ; Department of Pediatrics, University of California, La Jolla, CA, USA
| | - Taylor A Doherty
- Department of Medicine, University of California, La Jolla, CA, USA
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21
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Cohen HA, Blau H, Hoshen M, Batat E, Balicer RD. Seasonality of asthma: a retrospective population study. Pediatrics 2014; 133:e923-32. [PMID: 24616356 DOI: 10.1542/peds.2013-2022] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Seasonal variations in asthma are widely recognized, with the highest incidence during September. This retrospective population study aimed to investigate whether this holds true in a large group of asthmatic children in primary care and to assess the impact of age, gender, urban/rural living, and population sector. METHODS The key study outcomes were the diagnosis of asthma exacerbations and asthma medication prescriptions, recorded by family physicians during 2005 to 2009. These were analyzed by "week of diagnosis" in Clalit Health Services' electronic medical record database. Regression models were built to assess relative strength of secular trends, seasonality, and age-group in explaining the incidence of asthma exacerbations. RESULTS A total of 919,873 children aged 2 to 15 years were identified. Of these, 82,234 (8.9%) were asthmatic, 61.6% boys and 38.4% girls; 49.1% aged 2 to 5 years, 24.1% 6 to 9 years, and 26.8% 10 to 15 years. We observed a 2.01-fold increase in pediatric asthma exacerbations and 2.28-fold increase in prescriptions of asthma bronchodilator medications during September (weeks 37-39 vs weeks 34-36) compared with August. The association between the opening of school and the incidence of asthma-related visits to the primary care physician was greatest in children aged 2 to 5 years (odds ratio, 2.15) and 6 to 11 years (1.90-fold). Adolescents (age 12-15 years) had a lesser peak (1.81-fold). In late fall there was a second rise, lasting with fluctuations throughout winter, with a trough in summer. CONCLUSIONS Returning to school after summer is strongly associated with an increased risk for asthma exacerbations and unscheduled visits to the primary care physician.
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22
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Amster ED, Haim M, Dubnov J, Broday DM. Contribution of nitrogen oxide and sulfur dioxide exposure from power plant emissions on respiratory symptom and disease prevalence. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2014; 186:20-28. [PMID: 24361356 DOI: 10.1016/j.envpol.2013.10.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 10/21/2013] [Accepted: 10/31/2013] [Indexed: 06/03/2023]
Abstract
This study investigates the association between exposure to ambient NOx and SO2 originating from power plant emissions and prevalence of obstructive pulmonary disease and related symptoms. The Orot Rabin coal-fired power plant is the largest power generating facility in the Eastern Mediterranean. Two novel methods assessing exposure to power plant-specific emissions were estimated for 2244 participants who completed the European Community Respiratory Health Survey. The "source approach" modeled emissions traced back to the power plant while the "event approach" identified peak exposures from power plant plume events. Respiratory symptoms, but not prevalence of asthma and COPD, were associated with estimates of power plant NOx emissions. The "source approach" yielded a better estimate of exposure to power plant emissions and showed a stronger dose-response relationship with outcomes. Calculating the portion of ambient pollution attributed to power plants emissions can be useful for air quality management purposes and targeted abatement programs.
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Affiliation(s)
- Eric D Amster
- University of Haifa, School of Public Health, Department of Occupational and Environmental Health, Haifa, Israel; Institute for Occupational and Environmental Medicine, Rambam Medical Center, Ministry of Health, Haifa, Israel; Harvard School of Public Health, Department of Environmental Health, Boston, USA.
| | - Maayan Haim
- Faculty of Civil and Environmental Engineering, Technion-Israel Institute of Technology, Haifa, Israel; Coalition for Public Health, Haifa, Israel
| | - Jonathan Dubnov
- University of Haifa, School of Public Health, Department of Occupational and Environmental Health, Haifa, Israel; Haifa District Office, Ministry of Health, Haifa, Israel
| | - David M Broday
- Faculty of Civil and Environmental Engineering, Technion-Israel Institute of Technology, Haifa, Israel
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Aggarwal AN, Chakrabarti A. Does climate mould the influence of mold on asthma? Lung India 2013; 30:273-6. [PMID: 24339481 PMCID: PMC3841680 DOI: 10.4103/0970-2113.120594] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Ashutosh Nath Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
The use of disease registries for clinical epidemiological studies has become increasingly common and has led to advancements in the understanding of many disease processes. The availability of demographic and disease characteristic data on large patient populations, coupled with the minimal cost and relative speed of conducting retrospective investigations, provide an attractive alternative to original data collection. However, limitations inherent to the data collection process can result in the loss of generalizability and introduce bias, leading to erroneous or invalid results. Recognition and identification of these limitations will be unique to each investigation and to the registry being used. The purpose of this article is to highlight the opportunities that registries provide for researchers while presenting potential pitfalls in their use. We conclude with a discussion of a practical approach when considering registry data for clinical research.
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25
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Methacholine challenge test results in children are season dependent. Lung 2013; 191:553-7. [PMID: 23839582 DOI: 10.1007/s00408-013-9486-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 06/12/2013] [Indexed: 01/04/2023]
Abstract
BACKGROUND It is known that several parameters influence the positivity of a methacholine challenge (MCH), including a recent viral disease, allergies, and air pollution. Reports regarding the influence of the season upon the positivity of MCH are scarce. The aim of this study was to assess the percentage of positive MCH tests per season. METHODS We retrospectively evaluated all MCH tests performed in children and adults in a single center over a 30-month period. The percentage of positive tests for summer was compared with that of other seasons. RESULTS A total of 155 challenges were performed in children (under 20 years old) and 527 in adults. Thirty-eight percent of the tests were positive in adults and 71 % in children. The percentage of positive tests in the summer was significantly lower than the percentage of positive results during the rest of the year in children (58.5 vs. 75.4 %, respectively; p = 0.046). By contrast, there was no difference between the seasons in adults (39 vs. 38 %, respectively; p = 0.92). CONCLUSIONS There is a difference of 22.4 % in the percentage of positive tests in the summer months compared to the rest of the year in children, suggesting a reduction in the sensitivity of the MCH test in the hot season. We suggest that in cases where asthma is strongly suspected in a child and the MCH test was negative in the summer, one should consider repeating the MCH test in another season.
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Wong GWK, Leung TF, Ko FWS. Changing prevalence of allergic diseases in the Asia-pacific region. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2013; 5:251-7. [PMID: 24003381 PMCID: PMC3756171 DOI: 10.4168/aair.2013.5.5.251] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 11/06/2012] [Indexed: 01/15/2023]
Abstract
Asia-Pacific is one of the most densely populated regions of the world and is experiencing rapid economic changes and urbanization. Environmental pollution is a significant problem associated with the rapid modernization of many cities in South Asia. It is not surprising that the prevalences of asthma and allergies are increasing rapidly, although the underlying reasons remain largely unknown. Many studies from this region have documented the changing prevalence of allergic diseases in various parts of the world. However, the methodologies used were neither standardized nor validated, making the results difficult to evaluate. The International Study of Asthma and Allergies in Childhood (ISAAC) has provided a global epidemiology map of asthma and allergic diseases, as well as the trend of changes in the prevalence of these diseases. Allergic sensitization is extremely common in many Asian communities. However, the prevalence of allergic diseases remains relatively rare. The rapid urbanization in the region, which increases environmental pollution and can affect the rural environment, will likely increase the prevalence of asthma and allergies in Asia.
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Affiliation(s)
- Gary W K Wong
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
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27
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Gonzalez-Barcala FJ, Aboal-Viñas J, Aira MJ, Regueira-Méndez C, Valdes-Cuadrado L, Carreira J, Garcia-Sanz MT, Takkouche B. Influence of pollen level on hospitalizations for asthma. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2013; 68:66-71. [PMID: 23428055 DOI: 10.1080/19338244.2011.638950] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The effect of pollen level on asthma hospitalizations is still under debate. The aim of this study was to analyze hospital admissions due to asthma and its relation with environmental pollen and meteorological factors. During 13 years, we included every patient admitted with asthma as primary or secondary diagnosis. For this purpose, we used a case-crossover analysis to compare pollen concentrations at the time of admission with values of the same variables 2 to 6 days before admission. We included 6,687 hospital admissions. High maximum temperature and low humidity were associated with lower risk of asthma admissions. High mean pollen levels exerted a moderate effect and high maximum pollen levels led to a dramatic increase of hospital admissions due to asthma, especially among females. In conclusion, environmental pollen level increases the risk of asthma hospital admissions.
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Affiliation(s)
- F J Gonzalez-Barcala
- Department of Respiratory Diseases, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
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28
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Hondula DM, Davis RE, Knight DB, Sitka LJ, Enfield K, Gawtry SB, Stenger PJ, Deaton ML, Normile CP, Lee TR. A respiratory alert model for the Shenandoah Valley, Virginia, USA. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2013; 57:91-105. [PMID: 22438053 DOI: 10.1007/s00484-012-0537-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 02/20/2012] [Accepted: 02/20/2012] [Indexed: 05/31/2023]
Abstract
Respiratory morbidity (particularly COPD and asthma) can be influenced by short-term weather fluctuations that affect air quality and lung function. We developed a model to evaluate meteorological conditions associated with respiratory hospital admissions in the Shenandoah Valley of Virginia, USA. We generated ensembles of classification trees based on six years of respiratory-related hospital admissions (64,620 cases) and a suite of 83 potential environmental predictor variables. As our goal was to identify short-term weather linkages to high admission periods, the dependent variable was formulated as a binary classification of five-day moving average respiratory admission departures from the seasonal mean value. Accounting for seasonality removed the long-term apparent inverse relationship between temperature and admissions. We generated eight total models specific to the northern and southern portions of the valley for each season. All eight models demonstrate predictive skill (mean odds ratio = 3.635) when evaluated using a randomization procedure. The predictor variables selected by the ensembling algorithm vary across models, and both meteorological and air quality variables are included. In general, the models indicate complex linkages between respiratory health and environmental conditions that may be difficult to identify using more traditional approaches.
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Affiliation(s)
- David M Hondula
- Department of Environmental Sciences, University of Virginia, Charlottesville, VA 22904, USA.
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Lee CC, Sheridan SC, Lin S. Relating weather types to asthma-related hospital admissions in New York State. ECOHEALTH 2012; 9:427-439. [PMID: 23224756 DOI: 10.1007/s10393-012-0803-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 10/08/2012] [Accepted: 10/16/2012] [Indexed: 06/01/2023]
Abstract
Many previous studies have looked into the relationship between asthma and individual weather variables, but comparatively few have looked at this relationship using holistic weather types (WTs). Utilizing the Spatial Synoptic Classification, this research considers up to 6 days of lag time while investigating the asthma-to-WT relationship in two age groups (under 18 and 18 and over) throughout New York State. Results indicate that a cold and dry WT in autumn corresponds to increased asthma admissions and spike days in admissions in New York City (NYC) for the school-aged population, while hot and dry WTs in summer correspond to spike days in asthma admissions in both age groups. However, results vary considerably for other regions, seasons and WTs, and spike day analysis yields clearer results than the analysis of total anomalous admissions. When stratified by multiple regions and age groups, the sample size of daily asthma admissions is a limiting factor outside of NYC.
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30
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Dapul-Hidalgo G, Bielory L. Climate change and allergic diseases. Ann Allergy Asthma Immunol 2012; 109:166-72. [PMID: 22920070 DOI: 10.1016/j.anai.2012.02.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 02/04/2012] [Accepted: 02/14/2012] [Indexed: 10/28/2022]
Affiliation(s)
- Gina Dapul-Hidalgo
- Center for Allergy and Asthma Research, Department of Medicine, State University of New York, Downstate Medical Center, Brooklyn, New York, USA
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31
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Buckley JP, Richardson DB. Seasonal modification of the association between temperature and adult emergency department visits for asthma: a case-crossover study. Environ Health 2012; 11:55. [PMID: 22898319 PMCID: PMC3489538 DOI: 10.1186/1476-069x-11-55] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 07/17/2012] [Indexed: 05/20/2023]
Abstract
BACKGROUND The objective of this study is to characterize the effect of temperature on emergency department visits for asthma and modification of this association by season. This association is of interest in its own right, and also important to understand because temperature may be an important confounder in analyses of associations between other environmental exposures and asthma. For example, the case-crossover study design is commonly used to investigate associations between air pollution and respiratory outcomes, such as asthma. This approach controls for confounding by month and season by design, and permits adjustment for potential confounding by temperature through regression modeling. However, such models may fail to adequately control for confounding if temperature effects are seasonal, since case-crossover analyses rarely account for interactions between matching factors (such as calendar month) and temperature. METHODS We conducted a case-crossover study to determine whether the association between temperature and emergency department visits for asthma varies by season or month. Asthma emergency department visits among North Carolina adults during 2007-2008 were identified using a statewide surveillance system. Marginal as well as season- and month-specific associations between asthma visits and temperature were estimated with conditional logistic regression. RESULTS The association between temperature and adult emergency department visits for asthma is near null when the overall association is examined [odds ratio (OR) per 5 degrees Celsius = 1.01, 95% confidence interval (CI): 1.00, 1.02]. However, significant variation in temperature-asthma associations was observed by season (chi-square = 18.94, 3 degrees of freedom, p <0.001) and by month of the year (chi-square = 45.46, 11 degrees of freedom, p <0.001). ORs per 5 degrees Celsius were increased in February (OR = 1.06, 95% CI: 1.02, 1.10), July (OR = 1.16, 95% CI: 1.04, 1.29), and December (OR = 1.04, 95% CI: 1.01, 1.07) and decreased in September (OR = 0.92, 95% CI: 0.87, 0.97). CONCLUSIONS Our empirical example suggests that there is significant seasonal variation in temperature-asthma associations. Epidemiological studies rarely account for interactions between ambient temperature and temporal matching factors (such as month of year) in the case-crossover design. These findings suggest that greater attention should be given to seasonal modification of associations between temperature and respiratory outcomes in case-crossover analyses of other environmental asthma triggers.
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Affiliation(s)
- Jessie P Buckley
- Department of Epidemiology, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27599-7435, USA
| | - David B Richardson
- Department of Epidemiology, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27599-7435, USA
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Daily effects of air pollutants and pollen types on asthma and COPD hospital emergency visits in the industrial and Mediterranean Spanish city of Cartagena. Allergol Immunopathol (Madr) 2012; 40:231-7. [PMID: 21890258 DOI: 10.1016/j.aller.2011.05.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2011] [Accepted: 07/28/2011] [Indexed: 11/22/2022]
Abstract
BACKGROUND Associations found in time-series studies on hospital emergency room (ER) visits due to asthma and chronic obstructive pulmonary disease (COPD) with single air pollutants show some lack of consistency. The respiratory effects of aeroallergens in the air pollution mix are not well established. Non-linear relationships of different airborne pollen types with certain respiratory diseases have also been described. We aim to study the short-term effects of major air pollutants and aeroallergen pollen on asthma and COPD hospital ER visits in the industrial and Mediterranean Spanish city of Cartagena during 1995-1998. METHODS The association of asthma and COPD to ER visits with mean levels of sulphur and nitrogen dioxides (SO(2) and NO(2)), total suspended particles (TSP), ozone (O(3)), and the main allergenic airborne pollen types were analysed using Poisson regression with Generalised Additive Models, taking into account delayed effects and adjusting for long-term trends, seasonality, weather conditions, holidays and flu notifications. RESULTS Multipollutant models showed a similar relative risk (RR) increase (in %), of around 5% in asthma and COPD ER visits per 10 μg/m(3) SO(2) increments. The risk of an ER visit for the same NO(2) increment was 2.6% for asthma and 3.3% for COPD. Visits to the ER due to asthma showed a positive increase with both Urticaceae and Poaceae levels, but did not substantially modify the previous percentages. CONCLUSIONS Air levels of SO(2) and NO(2) were associated with a substantial increased risk in ER visits due to asthma and COPD. The inclusion of Poaceae and Urticaceae pollen did not alter that association.
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Glad JA, Brink LL, Talbott EO, Lee PC, Xu X, Saul M, Rager J. The relationship of ambient ozone and PM(2.5) levels and asthma emergency department visits: possible influence of gender and ethnicity. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2012; 67:103-8. [PMID: 22524651 DOI: 10.1080/19338244.2011.598888] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
ABSTRACT An investigation of the relationship of air pollution and emergency department (ED) visits for asthma was an opportunity to assess environmental risks for asthma exacerbations in an urban population. A total of 6,979 individuals with a primary discharge diagnosis of asthma presented to 1 of 6 EDs in the Pittsburgh, Pennsylvania, area between 2002 and 2005. Using a case-crossover methodology, which controls for the effects of subject-specific covariates such as gender and race, a 2.5% increase was observed in asthma ED visits for each 10 ppb increase in the 1-hour maximum ozone level on day 2 (odds ratio [OR] = 1.025, p < .05). Particulate matter with an aerodynamic diameter ≤2.5 μm (PM(2.5)) had an effect both on the total population on day 1 after exposure (1.036, p < .05), and on African Americans on days 1, 2, and 3. PM(2.5) had no significant effect on Caucasian Americans alone. The disparity in risk estimates by race may reflect differences in residential characteristics, exposure to ambient air pollution, or a differential effect of pollution by race.
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Affiliation(s)
- Jo Ann Glad
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA
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35
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Moustris KP, Douros K, Nastos PT, Larissi IK, Anthracopoulos MB, Paliatsos AG, Priftis KN. Seven-days-ahead forecasting of childhood asthma admissions using artificial neural networks in Athens, Greece. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2011; 22:93-104. [PMID: 21854178 DOI: 10.1080/09603123.2011.605876] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Artificial Neural Network (ANN) models were developed and applied in order to predict the total weekly number of Childhood Asthma Admission (CAA) at the greater Athens area (GAA) in Greece. Hourly meteorological data from the National Observatory of Athens and ambient air pollution data from seven different areas within the GAA for the period 2001-2004 were used. Asthma admissions for the same period were obtained from hospital registries of the three main Children's Hospitals of Athens. Three different ANN models were developed and trained in order to forecast the CAA for the subgroups of 0-4, 5-14-year olds, and for the whole study population. The results of this work have shown that ANNs could give an adequate forecast of the total weekly number of CAA in relation to the bioclimatic and air pollution conditions. The forecasted numbers are in very good agreement with the observed real total weekly numbers of CAA.
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Affiliation(s)
- Kostas P Moustris
- Department of Mechanical Engineering, Technological Education Institute of Piraeus, Athens, Greece
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Sheffield PE, Weinberger KR, Ito K, Matte TD, Mathes RW, Robinson GS, Kinney PL. The association of tree pollen concentration peaks and allergy medication sales in new york city: 2003-2008. ISRN ALLERGY 2011; 2011:537194. [PMID: 23724230 PMCID: PMC3658798 DOI: 10.5402/2011/537194] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 03/08/2011] [Indexed: 11/23/2022]
Abstract
The impact of pollen exposure on population allergic illness is poorly characterized. We explore the association of tree pollen and over-the-counter daily allergy medication sales in the New York City metropolitan area. Dates of peak tree pollen (maple, oak, and birch) concentrations were identified from 2003 to 2008. Daily allergy medication sales reported to the city health department were analyzed as a function of the same-day and lagged tree pollen peak indicators, adjusting for season, year, temperature, and day of week. Significant associations were found between tree pollen peaks and allergy medication sales, with the strongest association at 2-day lag (excess sales of 28.7% (95% CI: 17.4-41.2) over the average sales during the study period). The cumulative effect over the 7-day period on and after the tree pollen peak dates was estimated to be 141.1% (95% CI: 79.4-224.1). In conclusion, tree pollen concentration peaks were followed by large increases in over-the-counter allergy medication sales.
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Affiliation(s)
- Perry E. Sheffield
- Departments of Pediatrics and Preventive Medicine, Mount Sinai School of Medicine, 1 Gustave L. Levy Pl., Box 1512, New York, NY 10029, USA
| | - Kate R. Weinberger
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032-3727, USA
| | - Kazuhiko Ito
- Department of Environmental Medicine, New York University School of Medicine, New York, NY 10016, USA
| | - Thomas D. Matte
- Urban Public Health Program, Hunter College, City University of New York School of Public Health, New York, NY 10010, USA
| | - Robert W. Mathes
- New York City Department of Health and Mental Hygiene, Bureau of Environmental Surveillance and Policy, New York, NY 10007, USA
| | - Guy S. Robinson
- Louis Calder Center, Biological Field Station, Fordham University, Armonk, New York, NY 10504-1104, USA
| | - Patrick L. Kinney
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032-3727, USA
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Jariwala SP, Kurada S, Moday H, Thanjan A, Bastone L, Khananashvili M, Fodeman J, Hudes G, Rosenstreich D. Association between tree pollen counts and asthma ED visits in a high-density urban center. J Asthma 2011; 48:442-8. [PMID: 21453203 DOI: 10.3109/02770903.2011.567427] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Asthma exacerbation patterns are cyclic in nature and often correlate with air particle concentrations. OBJECTIVE To examine the relationship between asthma-related emergency department (ED) visits and outdoor air quality for pediatric and adult patients in a high asthma prevalence area, the New York City borough of the Bronx. METHODS Numbers of daily asthma-related adult and pediatric ED visits during one complete year (1999) were obtained from the seven major Bronx hospitals. Daily values of nitrogen oxides (NO(x)), ozone (O(3)), sulfur dioxide (SO(2)), and pollen counts were acquired. RESULTS Asthma-related ED visit numbers were highest in December-January and lowest in July. There were three distinct peaks of increased asthma ED visits: winter (December-January), spring (late April-May), and fall (October). The spring peak was the most striking and coincided with high tree pollen counts (tree pollen: r = 0.90, p = .03). We observed a positive correlation between asthma ED visits in the winter and SO(2) and NO(x) levels. Winter peaks of SO(2) and NO(x) in early December appeared to precede the winter asthma peak. CONCLUSIONS The spring asthma peak is closely associated with increased tree pollen counts, and the asthma increase at this time is likely due to allergic reactions to pollen. No significant associations could be established with the fall peak. The winter peak correlates with elevated SO(2) and NO(x) levels.
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Affiliation(s)
- Sunit P Jariwala
- Department of Medicine, Allergy/Immunology Division, Albert Einstein College of Medicine, Bronx, New York 10463, USA.
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Raphoz M, Goldberg MS, Garneau M, Héguy L, Valois MF, Guay F. Associations between atmospheric concentrations of spores and emergency department visits for asthma among children living in Montreal. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2010; 65:201-210. [PMID: 21186425 DOI: 10.1080/19338241003730937] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The authors carried out a time-series study to determine whether short-term increases in the concentrations of spores were associated with emergency department visits from asthma among children 0 to 9 years of age in Montreal, 1994-2004. Concentrations of spores were obtained from one sampling monitor. The authors used parametric Poisson models to model the association between daily admissions to emergency rooms for asthma and ambient exposures to a variety of spores, adjusting for secular trends, changes in weather, and chemical pollutants. For first admissions and exposures to Basidiomycetes, the authors found positive associations at all lags but the concurrent day. For Deuteromycetes and Cladosporium, risks were positive starting at lag 3 days and diminished at lag 6 days. There was little evidence of associations for readmissions, except for Basidiomycetes. The results indicate that Basidiomycetes and Cladosporium spores may be implicated in the exacerbation of asthma among children, most notably in the case of first-time visits to emergency departments, and that the effects appear to be delayed by several days.
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Affiliation(s)
- Marie Raphoz
- Department of Geography, Universite du Quebec a Montreal, Montreal, Quebec, Canada
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Nastos PT, Paliatsos AG, Anthracopoulos MB, Roma ES, Priftis KN. Outdoor particulate matter and childhood asthma admissions in Athens, Greece: a time-series study. Environ Health 2010; 9:45. [PMID: 20667130 PMCID: PMC2920864 DOI: 10.1186/1476-069x-9-45] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Accepted: 07/28/2010] [Indexed: 05/25/2023]
Abstract
BACKGROUND Particulate matter with diameter less than 10 micrometers (PM10) that originates from anthropogenic activities and natural sources may settle in the bronchi and cause adverse effects possibly via oxidative stress in susceptible individuals, such as asthmatic children. This study aimed to investigate the effect of outdoor PM10 concentrations on childhood asthma admissions (CAA) in Athens, Greece. METHODS Daily counts of CAA from the three Children's Hospitals within the greater Athens' area were obtained from the hospital records during a four-year period (2001-2004, n = 3602 children). Mean daily PM10 concentrations recorded by the air pollution-monitoring network of the greater Athens area were also collected. The relationship between CAA and PM10 concentrations was investigated using the Generalized Linear Models with Poisson distribution and logistic analysis. RESULTS There was a statistically significant (95% CL) relationship between CAA and mean daily PM10 concentrations on the day of exposure (+3.8% for 10 microg/m3 increase in PM10 concentrations), while a 1-day lag (+3.4% for 10 microg/m3 increase in PM10 concentrations) and a 4-day lag (+4.3% for 10 microg/m3 increase in PM10 concentrations) were observed for older asthmatic children (5-14 year-old). High mean daily PM10 concentration (the highest 10%; >65.69 microg/m3) doubled the risk of asthma exacerbations even in younger asthmatic children (0-4 year-old). CONCLUSIONS Our results provide evidence of the adverse effect of PM10 on the rates of paediatric asthma exacerbations and hospital admissions. A four-day lag effect between PM10 peak exposure and asthma admissions was also observed in the older age group.
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Affiliation(s)
- Panagiotis T Nastos
- Laboratory of Climatology and Atmospheric Environment, Department of Geology and Geoenvironment, University of Athens, Panepistimioupolis, 157 84 Athens, Greece
| | - Athanasios G Paliatsos
- General Department of Mathematics, Technological and Education Institute of Piraeus, 250 Thivon and P. Ralli Str., 122 44 Athens, Greece
| | | | - Eleftheria S Roma
- First Department of Paediatrics, University of Athens, Aghia Sophia Children's Hospital, Thebon and Lebadias Street, Athens 11527, Greece
| | - Kostas N Priftis
- Allergy-Pneumonology Department, Penteli Children's Hospital, 152 36 P. Penteli, Greece
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Mireku N, Wang Y, Ager J, Reddy RC, Baptist AP. Changes in weather and the effects on pediatric asthma exacerbations. Ann Allergy Asthma Immunol 2009; 103:220-4. [PMID: 19788019 DOI: 10.1016/s1081-1206(10)60185-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Pediatric asthma exacerbations may correlate with changes in weather, yet this relationship is not well defined. OBJECTIVE To determine the effects of fluctuations in climatic factors (temperature, humidity, and barometric pressure) on pediatric asthma exacerbations. METHODS A retrospective study was performed at 1 large urban hospital during a 2-year period (January 1, 2004, to December 31, 2005). Children presenting to the emergency department (ED) for an asthma exacerbation were included. Data on climactic factors, pollutants, and aeroallergens were collected daily. The relationship of daily (intraday) or between-day (interday) changes in climactic factors and asthma ED visits was evaluated using time series analysis, controlling for seasonality, air pollution, and aeroallergen exposure. The effects of climactic factors were evaluated on the day of admission (T=0) and up to 5 days before admission (T-5 through T-1). RESULTS There were 25,401 asthma ED visits. A 10% intraday increase in humidity on day T-1 or day T-2 was associated with approximately 1 additional ED visit for asthma (P < .001 and P = .01, respectively). Interday changes in humidity from day T - 3 to T-2 were also associated with more ED visits (P < .001). Interday changes in temperature from T-1 to T = 0 increased ED visits, with a 10 degrees F increase being associated with 1.8 additional visits (P = .006). No association was found with changes in barometric pressure. CONCLUSION Fluctuations in humidity and temperature, but not barometric pressure, appear to influence ED visits for pediatric asthma. The additional ED visits occur 1 to 2 days after the fluctuation.
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Affiliation(s)
- Nana Mireku
- Division of Allergy and Immunology; Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan, USA
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Scheuerman O, Meyerovitch J, Marcus N, Hoffer V, Batt E, Garty BZ. The September epidemic of asthma in Israel. J Asthma 2009; 46:652-5. [PMID: 19728199 DOI: 10.1080/02770900902963102] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The seasonality of asthma morbidity is well recognized. A peak in asthma exacerbations in September has been noted for years at our center. OBJECTIVE To examine the hypothesis that the increment in asthma exacerbations in September is influenced by the beginning of the kindergarten and school year. METHODS The monthly admission rate for asthma in patients of different ages was retrospectively evaluated in seven hospitals from various areas in Israel from January 2003 to December 2005. RESULTS Of the 408,242 hospital admissions during the study period, 8,011 were for asthma exacerbations: 4,091 in adults (1.3% of adult admissions) and 3,920 in children (3.8% of pediatric admissions). The asthma admission rates varied considerably throughout the year, with a peak of 4% of total admissions in the winter months and a nadir of 2% in the summer months. September was unique for its particularly high rate of admissions for asthma attacks in children (6% of total admissions), especially toddlers and the school-age group. In adults there was a progressive increase in asthma admissions from September through December without a unique peak in September. CONCLUSIONS There is a characteristic increase in asthma exacerbations and admissions in September in the pediatric age group. This phenomenon might be explained by the increased exposure to respiratory viruses, to new allergen exposure in school or kindergarten, increased emotional stress due to start of the new school year, or poor compliance and withdrawal of treatment during the summer. Clinicians should consider administering prophylactic treatment for asthma in children before onset of the school year.
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Affiliation(s)
- Oded Scheuerman
- Department of Pediatrics B and Kipper Institute of Allergy and Immunology, Schneider Children's Medical Center of Israel, Petah Tiqwa, Israel.
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Reid CE, Gamble JL. Aeroallergens, allergic disease, and climate change: impacts and adaptation. ECOHEALTH 2009; 6:458-70. [PMID: 19908096 PMCID: PMC2880235 DOI: 10.1007/s10393-009-0261-x] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Recent research has shown that there are many effects of climate change on aeroallergens and thus allergic diseases in humans. Increased atmospheric carbon dioxide concentration acts as a fertilizer for plant growth. The fertilizing effects of carbon dioxide, as well as increased temperatures from climate change, increase pollen production and the allergen content of pollen grains. In addition, higher temperatures are changing the timing and duration of the pollen season. As regional climates change, plants can move into new areas and changes in atmospheric circulation can blow pollen- and spore-containing dust to new areas, thus introducing people to allergens to which they have not been exposed previously. Climate change also influences the concentrations of airborne pollutants, which alone, and in conjunction with aeroallergens, can exacerbate asthma or other respiratory illnesses. The few epidemiological analyses of meteorological factors, aeroallergens, and allergic diseases demonstrate the pathways through which climate can exert its influence on aeroallergens and allergic diseases. In addition to the need for more research, there is the imperative to take preventive and adaptive actions to address the onset and exacerbation of allergic diseases associated with climate variability and change.
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Affiliation(s)
- Colleen E. Reid
- Environmental Health Sciences Division, School of Public Health, University of California, Berkeley, 50 University Hall, Berkeley, CA 94720 USA
| | - Janet L. Gamble
- Global Change Research Program, National Center for Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, 1200 Pennsylvania Avenue, NW (MC 8601P), Washington, DC 20460 USA
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Abe T, Tokuda Y, Ohde S, Ishimatsu S, Nakamura T, Birrer RB. The relationship of short-term air pollution and weather to ED visits for asthma in Japan. Am J Emerg Med 2009; 27:153-9. [PMID: 19371521 DOI: 10.1016/j.ajem.2008.01.013] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Revised: 01/16/2008] [Accepted: 01/22/2008] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION The incidence of asthma exacerbation has been increasing in many countries. Environmental factors may play an important role in this trend. We aimed to investigate the relationship of weather conditions and air pollution to significant exacerbation of asthma. METHODS The daily number of emergency department (ED) visits by ambulance for asthma was collected through records of the Tokyo Fire Department from January 1 to December 31, 2005. We also collected daily air pollution levels and meteorological data for Tokyo during the same period. Meteorological data included minimum temperature, maximum barometric pressure, maximum relative humidity, and precipitation. Measured air pollutants included sulfur dioxide, nitrogen monoxide, nitrogen oxides, suspended particulate matter, and carbon monoxide. We performed a time series analysis using multivariable-adjusted autoregressive integrated moving average model. The analysis was conducted separately among adults and among children (<15 years old). RESULTS Of a total of 643,849 patients who were transported to the ED by ambulance, there were 6447 patients with exacerbation of asthma. Among adults, lower minimum temperature was significantly associated with increased transport. Among children, there were no significant associations between exacerbation of asthmas requiring emergency transport and air pollutants or meteorological factors. The highest number of transports was found on October 11, the day after the National Sports Day in Japan. CONCLUSIONS Cold temperature is related to an increased risk of significant exacerbation of asthma in adults. Air pollution does not seem to play a major role in significant exacerbation of asthma requiring ambulance transports to ED.
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Affiliation(s)
- Toshikazu Abe
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo 104-8560, Japan.
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What have we learnt from ISAAC phase III in the Asia-Pacific rim? Curr Opin Allergy Clin Immunol 2009; 9:116-22. [PMID: 19326506 DOI: 10.1097/aci.0b013e3283292256] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW International Study of Asthma and Allergies in Childhood (ISAAC) phase III had provided a worldwide map of epidemiology of asthma and allergic diseases, as well as the changes in prevalence rate of these diseases when compared to data obtained in phase I. The wide variations of environmental factors and ethnic background in Asia provide excellent opportunities for research into the environmental and genetic determinants of asthma and allergies. This review summarizes important lessons learnt from ISAAC phase III results from Asia on asthma and allergy. RECENT FINDINGS ISAAC phase III provided epidemiological evidence of the wide variation and increasing prevalence of asthma and allergy in many Asian countries. When compared to other regions of the world, Asia has a relatively lower prevalence of asthma and allergic diseases. Comparative studies of populations of the same ethnic group living in different environments reveal striking disparity in prevalence of asthma and allergic diseases. The established risk factors could not explain the secular trend and variations of asthma prevalence in different Asian countries. Further research is needed in this rapidly changing region of Asia in order to identify the protective or risk factors associated with the development of asthma. SUMMARY ISAAC phase III provides standardized data on the prevalence and burden of asthma and allergy in the Asia-Pacific region. Further research is needed to reveal the underlying factors responsible for the wide variations in disease manifestations in the region.
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Sears MR. Epidemiology of asthma exacerbations. J Allergy Clin Immunol 2008; 122:662-668. [PMID: 19014756 DOI: 10.1016/j.jaci.2008.08.003] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Revised: 07/31/2008] [Accepted: 08/01/2008] [Indexed: 11/29/2022]
Abstract
Exacerbations of asthma sufficient to require urgent medical intervention are often, but not always, associated with viral infection, especially rhinovirus, with significant interaction with allergen sensitization and exposure. Seasonal patterns of exacerbations are seen especially in children, and may be aggravated by lack of adequate maintenance anti-inflammatory drug treatment during the high-risk viral season most well described in the Northern Hemisphere after school return in September. Age and sex differences in the epidemiology of exacerbations remain less than fully explained, but hormonal influences are demonstrable. Frequent exacerbations may be an indication of greater severity of disease, significant comorbidities, or poor compliance with therapy. Recognizing risk factors for exacerbations and implementing appropriate long-term management strategies coupled with improved compliance should reduce morbidity and mortality associated with asthma exacerbations.
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Affiliation(s)
- Malcolm R Sears
- McMaster University and Firestone Institute for Respiratory Health, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.
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Joseph PM. Can fine particulate matter explain the paradoxical ozone associations? ENVIRONMENT INTERNATIONAL 2008; 34:1185-91. [PMID: 18430471 DOI: 10.1016/j.envint.2008.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Revised: 02/27/2008] [Accepted: 03/05/2008] [Indexed: 05/03/2023]
Abstract
Our previous paper entitled "Paradoxical ozone associations could be due to methyl nitrite from combustion of methyl ethers or esters in engine fuels" (Env. Int.. 2007;33;1090) reviewed 11 studies of the impact of ozone on human health that, paradoxically, found a negative coefficient for ozone-morbidity associations. We argued that the most likely explanation for this effect would be methyl nitrite (MN) as an unsuspected exhaust component of engines with methyl ether in the fuel. The basis of the argument was the fact that MN is rapidly destroyed by sunlight, so that MN would be negatively correlated with ozone. All (but one) of the reviewed studies concluded that criterion pollutants could not explain the negative slope. The argument was strengthened by the observation that such paradoxical ozone associations have not been found in regions without significant methyl ether in gasoline. Left unaddressed in the previous paper was the possibility that fine particulate matter (FPM) might explain the POA. If this were true, then it would be necessary that the FPM be negatively correlated with ozone in those regions that found a POA. The current paper reviews data on FPM-ozone correlations in those regions where a POA was identified. The results show that FPM was, in most cases, positively correlated with ozone and so could not explain the POA.
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Affiliation(s)
- Peter M Joseph
- Department of Radiology, School of Medicine, University of Pennsylvania, Philadelphia, PA 19104-4283, USA.
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Nastos PT, Paliatsos AG, Papadopoulos M, Bakoula C, Priftis KN. The effect of weather variability on pediatric asthma admissions in Athens, Greece. J Asthma 2008; 45:59-65. [PMID: 18259997 DOI: 10.1080/02770900701815818] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The aim of this study was to determine whether there is any association between weather variability and asthma admissions among children in Athens, Greece. Medical data were obtained from hospital registries of the three main Children's Hospitals in Athens during the 1978-2000 period; children were classified into two age groups: 0-4 and 5-14 years. The application of Generalized Linear Models with Poisson distribution revealed a significant relationship among asthma hospitalizations and the investigated parameters, especially for the children aged 0-4 years. Our findings showed that Hospital admissions for childhood asthma in Athens, Greece, is negatively correlated with discomfort index, air temperature and absolute humidity whereas there is a positive correlation with cooling power, relative humidity and wind speed.
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Affiliation(s)
- Panagiotis T Nastos
- Laboratory of Climatology and Atmospheric Environment, Department of Geology and Geoenvironment, University of Athens, Greece
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Héguy L, Garneau M, Goldberg MS, Raphoz M, Guay F, Valois MF. Associations between grass and weed pollen and emergency department visits for asthma among children in Montreal. ENVIRONMENTAL RESEARCH 2008; 106:203-11. [PMID: 18093580 DOI: 10.1016/j.envres.2007.10.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2007] [Revised: 10/04/2007] [Accepted: 10/10/2007] [Indexed: 05/23/2023]
Abstract
CONTEXT AND OBJECTIVE Asthma among children is a major public health problem worldwide. There are increasing number of studies suggesting a possible association between allergenic pollen and exacerbations of asthma. In the context of global climate change, a number of future climate and air pollution scenarios predict increases in concentrations of pollen, an extension of the pollen season, and an increase in the allergenicity of pollen. The goal of the present study is to evaluate the short-term effects of exposure to grass and weed pollen on emergency department visits and readmissions for asthma among children aged 0-9 years living in Montreal between April and October, 1994-2004. METHODOLOGY AND RESULTS Time-series analyses were carried out using parametric log-linear overdispersed Poisson models that were adjusted for temporal variations, daily weather conditions (temperature, atmospheric pressure), and gaseous air pollutants (ozone and nitrogen dioxide). We have found positive associations between emergency department visits and concentrations of grass pollen 3 days after exposure. The effect of grass pollen was higher on emergency department readmissions as compared to initial visits. Weak negative associations were found between weed pollen (including ragweed pollen) and emergency department visits 2 days after exposure. CONCLUSION The data indicate that among children, emergency department visits increased with increasing concentrations of grass pollen.
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Affiliation(s)
- Léa Héguy
- Geography Department, Université du Québec à Montréal, Montréal, Que., Canada.
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Villeneuve PJ, Chen L, Rowe BH, Coates F. Outdoor air pollution and emergency department visits for asthma among children and adults: a case-crossover study in northern Alberta, Canada. Environ Health 2007; 6:40. [PMID: 18157917 PMCID: PMC2254596 DOI: 10.1186/1476-069x-6-40] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Accepted: 12/24/2007] [Indexed: 05/21/2023]
Abstract
BACKGROUND Recent studies have observed positive associations between outdoor air pollution and emergency department (ED) visits for asthma. However, few have examined the possible confounding influence of aeroallergens, or reported findings among very young children. METHODS A time stratified case-crossover design was used to examine 57,912 ED asthma visits among individuals two years of age and older in the census metropolitan area of Edmonton, Canada between April 1, 1992 and March 31, 2002. Daily air pollution levels for the entire region were estimated from three fixed-site monitoring stations. Similarly, daily levels of aeroallergens were estimated using rotational impaction sampling methods for the period between 1996 and 2002. Odds ratios and their corresponding 95% confidence intervals were estimated using conditional logistic regression with adjustment for temperature, relative humidity and seasonal epidemics of viral related respiratory disease. RESULTS Positive associations for asthma visits with outdoor air pollution levels were observed between April and September, but were absent during the remainder of the year. Effects were strongest among young children. Namely, an increase in the interquartile range of the 5-day average for NO2 and CO levels between April and September was associated with a 50% and 48% increase, respectively, in the number of ED visits among children 2 - 4 years of age (p < 0.05). Strong associations were also observed with these pollutants among those 75 years of age and older. Ozone and particulate matter were also associated with asthma visits. Air pollution risk estimates were largely unchanged after adjustment for aeroallergen levels. CONCLUSION Our findings, taken together, suggest that exposure to ambient levels of air pollution is an important determinant of ED visits for asthma, particularly among young children and the elderly.
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Affiliation(s)
- Paul J Villeneuve
- Biostatistics and Epidemiology Division, Health Canada, Ottawa, Ontario, Canada
| | - Li Chen
- Biostatistics and Epidemiology Division, Health Canada, Ottawa, Ontario, Canada
| | - Brian H Rowe
- University of Alberta Hospital, 8440-112th Street, Edmonton, Alberta, Canada
| | - Frances Coates
- Aerobiology Research Laboratories, Ottawa, Ontario, Canada
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Joseph PM. Paradoxical ozone associations could be due to methyl nitrite from combustion of methyl ethers or esters in engine fuels. ENVIRONMENT INTERNATIONAL 2007; 33:1090-106. [PMID: 17716731 DOI: 10.1016/j.envint.2007.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2006] [Revised: 07/06/2007] [Accepted: 07/10/2007] [Indexed: 05/16/2023]
Abstract
We review studies of the effects of low ambient ozone concentrations on morbidity that found a negative coefficient for ozone concentration. We call this a Paradoxical Ozone Association (POA). All studies were in regions with methyl ether in gasoline. All but one study carefully controlled for the effects of other criterion pollutants, so the phenomenon cannot be attributed to them. One was in southern California in mid-summer when ozone levels are highest. Because ozone is created by sunlight, the most plausible explanation for a POA would be an ambient pollutant that is rapidly destroyed by sunlight, such as methyl nitrite (MN). A previously published model of engine exhaust chemistry suggested methyl ether in the fuel will create MN in the exhaust. MN is known to be highly toxic, and closely related alkyl nitrites are known to induce respiratory sensitivity in humans. Support for the interpretation comes from many studies, including three linking asthma symptoms to methyl tertiary butyl ether (MTBE) and the observation that a POA has not been seen in regions without ether in gasoline. We also note that studies in southern California show a historical trend from more significant to less significant ozone-health associations. The timing of those changes is consistent with the known timing of the introduction of gasoline oxygenated with MTBE in that region.
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Affiliation(s)
- Peter M Joseph
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104-4283, USA.
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