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
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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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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
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.
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JK: Conceptualization, Investigation, Writing- Original draft preparation, Visualization. FM: Conceptualization, Investigation, Writing- Reviewing and Editing. HH.: Conceptualization, Supervision, Writing- Reviewing and Editing.
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Kelchtermans, J., Mentch, F. & Hakonarson, H. Ambient air pollution sensitivity and severity of pediatric asthma. J Expo Sci Environ Epidemiol 34, 853–860 (2024). https://doi.org/10.1038/s41370-023-00573-7
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DOI: https://doi.org/10.1038/s41370-023-00573-7
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