Age-related association of fine particles and ozone with severe acute asthma in New York City

• Published in: Journal of allergy and clinical immunology Vol. 125; no. 2; pp. 367 - 373.e5
• Main Authors: Silverman, Robert A., MD, Ito, Kazuhiko, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.02.2010; Elsevier; Elsevier Limited
• Subjects: Adolescent; Adult; Age; Age Factors; Aged; Air Pollutants - adverse effects; Air pollution; Air Pollution - adverse effects; Allergy and Immunology; Asthma - etiology; Atmospheric pressure; Atoms & subatomic particles; Biological and medical sciences; Child; Child, Preschool; Chronic obstructive pulmonary disease, asthma; Coal-fired power plants; emergency; Estimates; exacerbation; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Generalized linear models; Hospitalization; Humans; Humidity; Immunopathology; Intensive care; intensive care unit; Medical sciences; Middle Aged; Morbidity; Mortality; New York City; ozone; Ozone - adverse effects; Particulate Matter - adverse effects; Patient Admission - statistics & numerical data; PM 2.5, asthma; Pneumology; Pollutants; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Seasons; Sensitivity analysis; Temperature effects; Variables; Young Adult; New York; United States; North America; America; New York City; United States > US; Particulate matter of 2.5 μm or less; PM 2.5, asthma; hospitalization; PM 2.5; emergency; IQR; ozone; exacerbation; National Ambient Air Quality Standard; ICD-9; International Classification of Diseases, Ninth Revision; Interquartile range; Air pollution; NAAQS; intensive care unit; ICU; age; Lung disease; Immunopathology; Urban environment; Respiratory disease; Ozone; Hospitalization; Intensive care unit; Asthma; Exacerbation; Association; Immunology; Fine particle; Bronchus disease; Obstructive pulmonary disease; Emergency; PM; Age
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2009.10.061

Background Ambient fine particles (particular matter <2.5 μm diameter [PM2.5 ]) and ozone exacerbate respiratory conditions including asthma. There is little documentation determining whether children are more vulnerable to the effects of ambient pollution than adults, or whether pollution causes life-threatening episodes requiring intensive care unit (ICU) admission. Objective We investigate the relationship between severe asthma morbidity and PM2.5 and ozone in the warm season, and determine whether there is an age-related susceptibility to pollution. Methods Daily time-series analysis of 6008 asthma ICU admissions and 69,375 general (non-ICU) asthma admissions in 4 age groups (<6, 6-18, 19-49, and 50+ years) in 74 New York City hospitals for the months April to August from 1999 to 2006. The regression model adjusted for temporal trends, weather, and day of the week. Risks were estimated for interquartile range increases in the a priori exposure time window of the average of 0-day and 1-day lagged pollutants. Results Age was a significant effect modifier for hospitalizations, and children age 6 to 18 years consistently had the highest risk. Among children age 6 to 18 years, there was a 26% (95% CI, 10% to 44%) increased rate of ICU admissions and a 19% increased rate of general hospitalizations (95% CI, 12% to 27%) for each 12-μg/m3 increase in PM2.5 . For each 22-ppb increase in ozone, there was a 19% (95% CI, 1% to 40%) increased risk for ICU admissions and a 20% (95% CI, 11% to 29%) increased risk for general hospitalizations. Conclusion Warm weather patterns of ozone and PM2.5 disproportionately affect children with asthma and appear responsible for severe attacks that could have been avoided.