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Severe and Moderate Asthma Exacerbations in Asthmatic Children and Exposure to Ambient Air Pollutants

Author

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  • Louis-Francois Tétreault

    (Department of Environmental and Occupational Health, School of Public Health, University of Montreal, Montréal, QC H2L 1M3, Canada
    Direction Régionale de Santé Publique du CIUSSS Centre-Sud-de-l’Île-de-Montréalde Montréal, Montréal, QC H2L 1M3, Canada)

  • Marieve Doucet

    (Institut Natonal de la Santé Publique du Québec, Québec, QC H2L 1M3, Canada
    Department of Medicine, Laval University, Québec, QC H2L 1M3, Canada)

  • Philippe Gamache

    (Institut Natonal de la Santé Publique du Québec, Québec, QC H2L 1M3, Canada)

  • Michel Fournier

    (Direction Régionale de Santé Publique du CIUSSS Centre-Sud-de-l’Île-de-Montréalde Montréal, Montréal, QC H2L 1M3, Canada)

  • Allan Brand

    (Institut Natonal de la Santé Publique du Québec, Québec, QC H2L 1M3, Canada)

  • Tom Kosatsky

    (British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada)

  • Audrey Smargiassi

    (Department of Environmental and Occupational Health, School of Public Health, University of Montreal, Montréal, QC H2L 1M3, Canada
    Institut Natonal de la Santé Publique du Québec, Québec, QC H2L 1M3, Canada
    Université de Montréal Public Health Research Institute, Montreal, QC H2L 1M3, Canada)

Abstract

Background: It is well established that short-term exposure to ambient air pollutants can exacerbate asthma, the role of early life or long-term exposure is less clear. We assessed the association between severe asthma exacerbations with both birth and annual exposure to outdoor air pollutants with a population-based cohort of asthmatic children in the province of Quebec (Canada). Method: Exacerbations of asthma occurring between 1 April 1996 and 31 March 2011 were defined as one hospitalization or emergency room visit with a diagnosis of asthma for children (<13 years old) already diagnosed with asthma. Annual daily average concentrations of ozone (O 3 ) and nitrogen dioxide (NO 2 ) were estimated at the child’s residential postal code. Satellite based levels of fine particulate (PM 2.5 ) estimated for a grid of 10 km by 10 km were also assigned to postal codes of residence for the whole province. Hazard ratios (HRs) were estimated from Cox models with a gap time approach for both birth and time-dependant exposure. Results: Of the 162,752 asthmatic children followed (1,020,280 person-years), 35,229 had at least one asthma exacerbation. The HRs stratified by age groups and adjusted for the year of birth, the ordinal number of exacerbations, sex, as well as material and social deprivation, showed an interquartile range increase in the time-dependant exposure to NO 2 (4.95 ppb), O 3 (3.85 ppb), and PM 2.5 (1.82 μg/m 3 ) of 1.095 (95% CI 1.058–1.131), 1.052 (95% CI 1.037–1.066) and 1.025 (95% CI 1.017–1.031), respectively. While a positive association was found to PM 2.5 , no associations were found between exposure at birth to NO 2 or O 3 . Conclusions: Our results support the conclusion, within the limitation of this study, that asthma exacerbations in asthmatic children are mainly associated with time dependent residential exposures less with exposure at birth.

Suggested Citation

  • Louis-Francois Tétreault & Marieve Doucet & Philippe Gamache & Michel Fournier & Allan Brand & Tom Kosatsky & Audrey Smargiassi, 2016. "Severe and Moderate Asthma Exacerbations in Asthmatic Children and Exposure to Ambient Air Pollutants," IJERPH, MDPI, vol. 13(8), pages 1-12, August.
    • Handle: RePEc:gam:jijerp:v:13:y:2016:i:8:p:771-:d:75131
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    References listed on IDEAS

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    1. Goodman, D.C. & Fisher, E. & Slukel, T.A. & Chang, C.-H., 1997. "The distance to community medical care and the likelihood of hospitalization: Is closer always better?," American Journal of Public Health, American Public Health Association, vol. 87(7), pages 1144-1150.
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    Cited by:

    1. Asim Anwar & Muhammad Ayub & Noman Khan & Antoine Flahault, 2019. "Nexus between Air Pollution and Neonatal Deaths: A Case of Asian Countries," IJERPH, MDPI, vol. 16(21), pages 1-10, October.
    2. Pierre Masselot & Fateh Chebana & Éric Lavigne & Céline Campagna & Pierre Gosselin & Taha B.M.J. Ouarda, 2019. "Toward an Improved Air Pollution Warning System in Quebec," IJERPH, MDPI, vol. 16(12), pages 1-14, June.
    3. Hiroshi Yamaguchi & Kandai Nozu & Shinya Ishiko & Atsushi Kondo & Takeshi Ninchoji & China Nagano & Hiroki Takeda & Ai Unzaki & Kazuto Ishibashi & Ichiro Morioka & Hiroaki Nagase & Kazumoto Iijima & A, 2021. "Impact of the State of Emergency during the COVID-19 Pandemic in 2020 on Asthma Exacerbations among Children in Kobe City, Japan," IJERPH, MDPI, vol. 18(21), pages 1-19, October.

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