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Ambient air pollution sensitivity and severity of pediatric asthma

Journal of Exposure Science & Environmental Epidemiology (2023)Cite this article

Abstract

Background

Ambient air pollution exposure increases the incidence and severity of pediatric asthma. Despite this, we lack effective therapies to protect patients from the impact of ambient air pollution exposure. A roadblock is the inability to identify patients that are affected by air pollution.

Objective

To examine the association between AAP sensitivity determined by individual exposure prior to asthma exacerbations and the severity of asthma in pediatric patients.

Methods

We assess the association between spikes in ambient air pollution and asthma exacerbations. Patients were considered sensitive to a specific pollutant if they experienced an asthma exacerbation immediately following a spike in the concentration of that pollutant. Cut off values for these spikes were determined as two standard deviations above the mean concentration two weeks prior and two weeks post the days leading up to an asthma exacerbation.

Results

We included 8129 pediatric patients with over 34,346 associated asthma exacerbations. In a multinomial log-linear logistic regression model comparing patients with mild asthma to patients with moderate or severe asthma, sensitivity to Ozone, SO2, PM2.5 and PM10 was significantly associated to severe as opposed to mild asthma (OR 1.39 with CI 1.08–1.78, 1.58 with CI 1.12–2.23, 1.37 with CI 1.07–1.76, and 1.63 with CI 1.12–2.37 respectively). Furthermore, moderate as opposed to mild asthma was significantly associated with sensitivity to SO2 and PM2.5 (OR 1.24 with CI 1.06–1.44 and 1.26 with CI 1.12–1.43, respectively).

Impact Statement

  • There is a subpopulation of pediatric asthma patients that experience asthma exacerbations just following spikes in ambient air pollution. This subgroup of patients has more severe asthma despite correction for significant confounders. The presented work is the first to reveal the clinically significant impact of variation in ambient air pollution sensitivity in pediatric asthma, highlighting the importance of accounting for variable sensitivity in the study of the effects of ambient air pollution exposure on pediatric asthma.

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Fig. 1: Schematic overview of program used to obtain and process the Air Quality System (AQS) data.
Fig. 2: Overview of Air Quality Index (AQI) by Ozone and PM2.5 just preceding asthma exacerbations (in blue) with control dates (in red).
Fig. 3: Overview of modelled ambient air pollution concentration just preceding asthma exacerbations (in blue) with control dates (in red).

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Data availability

The data that support the findings of this study are available from the corresponding author, JK, upon reasonable request.

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Funding

Funding

This work was supported by Institutional Development Funds and the Endowed Chair in Genomic Research grant from The Children’s Hospital of Philadelphia. Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number TL1TR001880. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This publication was made possible by grant number P30 ES013508 from the National Institute of Environmental Health Sciences (NIEHS), NIH. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIEHS, NIH.

Author information

Authors and Affiliations

  1. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Jelte Kelchtermans & Hakon Hakonarson

  2. The Center of Applied Genomics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Jelte Kelchtermans, Frank Mentch & Hakon Hakonarson

  3. Division of Pulmonary Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Jelte Kelchtermans & Hakon Hakonarson

Authors
  1. Jelte Kelchtermans
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  2. Frank Mentch
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  3. Hakon Hakonarson
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Contributions

JK: Conceptualization, Investigation, Writing- Original draft preparation, Visualization. FM: Conceptualization, Investigation, Writing- Reviewing and Editing. HH.: Conceptualization, Supervision, Writing- Reviewing and Editing.

Corresponding author

Correspondence to Jelte Kelchtermans.

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The authors declare no competing interests.

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Relevant ethical approval for this study was obtained.

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Kelchtermans, J., Mentch, F. & Hakonarson, H. Ambient air pollution sensitivity and severity of pediatric asthma. J Expo Sci Environ Epidemiol (2023). https://doi.org/10.1038/s41370-023-00573-7

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