Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Acute associations between PM2.5 and ozone concentrations and asthma exacerbations among patients with and without allergic comorbidities

Journal of Exposure Science & Environmental Epidemiology volume 30, pages 795–804 (2020)Cite this article

Abstract

Acute effects of outdoor air pollution on asthma exacerbations may vary by asthma phenotype (allergic vs nonallergic). Associations of ambient PM2.5 and ozone concentrations with acute asthma visits (office, urgent, emergency, and hospitalization) were investigated using electronic medical records. International Classification of Disease codes were used to identify asthmatics, and classify them based on the presence or absence of an allergic comorbidity in their medical records. Daily 24-h average PM2.5, 8-h maximum ozone, and mean temperature were obtained from a centralized monitor. Using a time-stratified case-crossover approach, pollutant concentrations were modeled using moving averages and distributed lag nonlinear models (lag 0–6) to examine lag associations and nonlinear concentration–response. The adjusted odds ratios for a 10 µg/m3 increase in 3-day moving average (lag 0–2) PM2.5 in the two-pollutant models among patients with and without allergic comorbidities were 1.10 (95% confidence interval [CI]: 1.07, 1.13) and 1.05 (95% CI: 1.02, 1.09), respectively; and for a 20 ppb increase in 3-day moving average (lag 0–2) ozone were 1.08 (95% CI: 1.02, 1.14) and 1.00 (95% CI: 0.95, 1.05), respectively. Estimated odds ratios among patients with allergic comorbidities were consistently higher across age, sex, and temperature categories. Asthmatics with an allergic comorbidity may be more susceptible to ambient PM2.5 and ozone.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Three-dimensional plots of distributed lag nonlinear model results from single pollutant models.
Fig. 2: Overall cumulative exposure–response for single pollutant models.
Fig. 3: Nonlinear concentration–response from distributed lag nonlinear models for individual lag days.
Fig. 4: Adjusted odds ratios for asthma visits from a two-pollutant model among asthma patients with and without an allergic comorbidity.

Similar content being viewed by others

References

  1. Schatz M, Rosenwasser L. The allergic asthma phenotype. J Allergy Clin Immunol Pract. 2014;2:645–8.

    Article  Google Scholar 

  2. Allergy and Asthma Foundation of America. Allergens and allergic asthma. 2015. https://www.aafa.org/allergic-asthma/.

  3. Gupta D, Ayres J. Brittle asthma: a seperate clinical phenotype of asthma. Indian J Chest Dis Allied Sci. 2001;43:33–8.

    CAS  PubMed  Google Scholar 

  4. Graziani E, Petroianni A, Terzano C. Brittle asthma. Eur Rev Med Pharmacol Sci. 2004 8:135–8.

    CAS  PubMed  Google Scholar 

  5. Romanet-Manent S, Charpin D, Magnan A, Lanteaume A, Vervloet D, the EGEA Cooperative Group. Allergic vs nonallergic asthma: what makes the difference? Allergy. 2002;57:607–13.

    Article  Google Scholar 

  6. Liou A, Grubb JR, Schechtman KB, Hamilos DL. Causative and contributive factors to asthma severity and patterns of medication use in patients seeking specialized asthma care. Chest. 2003;124:1781–8.

    Article  Google Scholar 

  7. Siroux V, Oryszczyn M-P, Paty E, Kauffmann F, Pison C, Vervloet D, et al. Relationships of allergic sensitization, total immunoglobulin E and blood eosinophils to asthma severity in children of the EGEA Study. Clin Exp Allergy. 2003;33:746–51.

    Article  CAS  Google Scholar 

  8. Cline MG, Dodge R, Lebowitz MD, Burrows B. Determinant of percent predicted FEV sub 1 in current asthmatic subjects. Chest. 1994;106:1089–93.

    Article  CAS  Google Scholar 

  9. U.S. EPA. Integrated Science Assessment (ISA) for Particulate Matter (Final Report, 2019). U.S. Washington, DC, EPA/600/R-19/188: Environmental Protection Agency; 2019.

  10. U.S. EPA. Integrated Science Assessment (ISA) for Ozone and Related Photochemical Oxidants (External Review Draft). Washington, DC, EPA/600/R-19/093: U.S. Environmental Protection Agency; 2019.

  11. Canova C, Dunster C, Kelly FJ, Minelli C, Shah PL, Caneja C, et al. PM10-induced hospital admissions for asthma and chronic obstructive pulmonary disease: the modifying effect of individual characteristics. Epidemiology. 2012;23:607–15.

    Article  Google Scholar 

  12. Glad JA, Brink LL, Talbott EO, Lee PC, Xu X, Saul M, et al. The relationship of ambient ozone and PM2.5 levels and asthma emergency department visits: possible influence of gender and ethnicity. Arch Environ Occup Health. 2012;67:103–8.

    Article  CAS  Google Scholar 

  13. Lavigne E, Villeneuve P, Cakmak S. Air pollution and emergency department visits for asthma in Windsor, Canada. Can J Public Health. 2012;103:4–8.

    Article  Google Scholar 

  14. Fitzgerald E, Pantea C, Lin S. Cold spells and the risk of hospitalization for asthma: New York, USA 1991–2006. Lung. 2014;192:947–54.

    Article  Google Scholar 

  15. Michelozzi P, Accetta G, De Sario M, D’Ippoliti D, Marino C, Baccini M, et al. High temperature and hospitalizations for cardiovascular and respiratory causes in 12 European cities. Am J Respir Crit Care Med. 2009;179:383–9.

    Article  Google Scholar 

  16. Mirabelli MC, Vaidyanathan A, Flanders WD, Qin X, Garbe P. Outdoor PM2.5, ambient air temperature, and asthma symptoms in the past 14 days among adults with active asthma. Environ Health Perspect. 2016;124:1882–90.

    Article  CAS  Google Scholar 

  17. American Lung Association. 2017 State of the air report. 2017. http://www.lung.org/assets/documents/healthy-air/state-of-the-air/state-of-the-air-2017.pdf.

  18. United States Environmental Protection Agency. Air data: air quality data collected at outdoor monitors across the US. 2018. https://www.epa.gov/outdoor-air-quality-data.

  19. United States Office of Personnel Management. Federal Holidays. 2018. https://www.opm.gov/policy-data-oversight/snow-dismissal-procedures/federal-holidays/#url=Overview.

  20. Gasparrini A, Armstrong B, Kenward MG. Distributed lag non-linear models. Stat Med. 2010;29:2224–34.

    Article  CAS  Google Scholar 

  21. Janes H, Sheppard L, Lumley T. Case-crossover analyses of air pollution exposure data: referent selection strategies and their implications for bias. Epidemiology. 2005;16:717–26.

    Article  Google Scholar 

  22. Clogg CC, Petkova E, Haritou A. Statistical methods for comparing regression coefficients between models. Am J Sociol. 1995;100:1261–93.

    Article  Google Scholar 

  23. Gasparrini A. Distributed lag linear and non-linear models in R: the package dlnm. J Stat Softw. 2011;43. http://www.jstatsoft.org/v43/i08/.

  24. Miller RL, Peden DB. Environmental effects on immune responses in patients with atopy and asthma. J Allergy Clin Immunol. 2014;134:1001–8.

    Article  CAS  Google Scholar 

  25. Gandhi VD, Vliagoftis H. Airway epithelium interactions with aeroallergens: role of secreted cytokines and chemokines in innate immunity. Front Immunol. 2015;6. http://journal.frontiersin.org/article/10.3389/fimmu.2015.00147/abstract.

  26. Dell SD, Jerrett M, Beckerman B, Brook JR, Foty RG, Gilbert NL, et al. Presence of other allergic disease modifies the effect of early childhood traffic-related air pollution exposure on asthma prevalence. Environ Int. 2014;65:83–92.

    Article  CAS  Google Scholar 

  27. Dong G-H, Chen T, Liu M-M, Wang D, Ma Y-N, Ren W-H, et al. Gender differences and effect of air pollution on asthma in children with and without allergic predisposition: Northeast Chinese children health study. PLoS ONE. 2011;6:e22470.

    Article  CAS  Google Scholar 

  28. Chen B-Y, Chen C-H, Chen P-C, Wang G-S, Guo YL. Air pollution, allergic co-morbidity, and emergency department visit for pediatric asthma in Taiwan. Aerosol Air Qual Res. 2013;13:1847–52.

    Article  CAS  Google Scholar 

  29. Noh J, Sohn J, Cho J, Cho S-K, Choi YJ, Kim C, et al. Short-term effects of ambient air pollution on emergency department visits for asthma: an assessment of effect modification by prior allergic disease history. J Prev Med Pub Health. 2016;49:329–41.

    Article  Google Scholar 

  30. Wade K, Mulholland J, Marmur A, Russell A, Hartsel B, Edgerton E, et al. Effects of instrument precision and spatial variability on the assessment of the temporal variation of ambient air pollution in Atlanta, Georgia. J Air Waste Manag Assoc. 2006;56:876–88.

    Article  CAS  Google Scholar 

  31. United States Environmental Protection Agency. Returning EPA to its core mission. 2019. https://www.epa.gov/home/returning-epa-its-core-mission.

  32. Lu Y, Zeger SL. On the equivalence of case-crossover and time series methods in environmental epidemiology. Biostatistics. 2007;8:337–44.

    Article  Google Scholar 

  33. Levy D, Lumley T, Sheppard L, Kaufman J, Checkoway H. Referent selection in case-crossover analyses of acute health effects of air pollution. Epidemiology. 2001;12:186–92.

    Article  CAS  Google Scholar 

  34. Lu Y, Symons JM, Geyh AS, Zeger SL. An approach to checking case-crossover analyses based on equivalence with time-series methods. Epidemiology. 2008;19:169–75.

    Article  Google Scholar 

Download references

Acknowledgements

The authors thank Gai Elhanan from the Renown Institute for Health Innovation and Andrew N. Joros from the Applied Innovation Center, Desert Research Institute.

Funding

WJM and JJG are funded through a grant from Renown Health to JJG; the Applied Innovation Center at DRI is funded through a grant from the Nevada Governor’s Office of Economic Development to JJG.

Author information

Authors and Affiliations

  1. School of Community Health Sciences, University of Nevada, Reno, NV, USA

    Natalie A. Rosenquist, So Young Ryu, Matthew J. Strickland & Lyndsey A. Darrow

  2. Renown Institute for Health Innovation, Reno, NV, USA

    William J. Metcalf, Max J. Coppes & Joe J. Grzymski

  3. Desert Research Institute, Reno, NV, USA

    William J. Metcalf & Joe J. Grzymski

  4. University of Nevada School of Medicine, Reno, NV, USA

    Aida Rutledge, Max J. Coppes, Matthew J. Strickland & Lyndsey A. Darrow

  5. Renown Children’s Hospital, Reno, NV, USA

    Max J. Coppes

Authors
  1. Natalie A. Rosenquist
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. William J. Metcalf
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. So Young Ryu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aida Rutledge
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Max J. Coppes
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Joe J. Grzymski
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Matthew J. Strickland
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Lyndsey A. Darrow
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Natalie A. Rosenquist.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rosenquist, N.A., Metcalf, W.J., Ryu, S.Y. et al. Acute associations between PM2.5 and ozone concentrations and asthma exacerbations among patients with and without allergic comorbidities. J Expo Sci Environ Epidemiol 30, 795–804 (2020). https://doi.org/10.1038/s41370-020-0213-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41370-020-0213-7

Keywords

This article is cited by

Search

Advanced search

Quick links