|Title||Short-term effects of multiple outdoor environmental factors on risk of asthma exacerbations: Age-stratified time-series analysis|
|Publication Type||Journal Article|
|Year of Publication||2019|
|Authors||Lee S.W, Yon D.K, James C.C, Lee S., Koh H.Y, Sheen Y.H, Oh J.W, Han M.Y, Sugihara G|
|Type of Article||Article|
|Keywords||aeroallergen; aeroallergens; air pollutant; air-pollution; Allergy; Asthma exacerbation; hospital admissions; human rhinovirus; Immunology; impact; influenza virus; symptoms; weather; weather condition|
Background: Although the different age groups had differences in sensitivity of asthma exacerbations (AEs) to environmental factors, no comprehensive study has examined the age-stratified effects of environmental factors on AEs. Objective: We sought to examine the short-term effects in age-stratified groups (infants, preschool children, school-aged children, adults, and the elderly) of outdoor environmental factors (air pollutants, weather conditions, aeroallergens, and respiratory viral epidemics) on AEs. Methods: We performed an age-stratified analysis of the short-term effects of 4 groups of outdoor environmental factors on AEs in Seoul Metropolitan City (Korea) from 2008 and 2012. The statistical analysis used a Poisson generalized linear regression model, with a distributed lag nonlinear model for identification of lagged and nonlinear effects and convergent cross-mapping for identification of causal associations. Results: Analysis of the total population (n = 10,233,519) indicated there were 28,824 AE events requiring admission to an emergency department during the study period. Diurnal temperature range had significant effects in pediatric (infants, preschool children, and school-aged children) and elderly (relative risk [RR], 1.056-1.078 and 1.016, respectively) subjects. Tree and weed pollen, human rhinovirus, and influenza virus had significant effects in school-aged children (RR, 1.014, 1.040, 1.042, and 1.038, respectively). Tree pollen and influenza virus had significant effects in adults (RR, 1.026 and 1.044, respectively). Outdoor air pollutants (particulate matter of <= 10 mu m in diameter, nitrogen dioxide, ozone, carbon monoxide, and sulfur dioxide) had significant short-term effects in all age groups (except for carbon monoxide and sulfur dioxide in infants). Conclusion: These findings provide a need for the development of tailored strategies to prevent AE events in different age groups.