Ambient air pollution sensitivity and severity of pediatric asthma

Jelte Kelchtermans; Frank Mentch; Hakon Hakonarson

doi:10.1038/s41370-023-00573-7

Ambient air pollution sensitivity and severity of pediatric asthma

J Expo Sci Environ Epidemiol. 2023 Jun 27:10.1038/s41370-023-00573-7. doi: 10.1038/s41370-023-00573-7. Online ahead of print.

Authors

Jelte Kelchtermans^{1

2

3}, Frank Mentch⁴, Hakon Hakonarson^{5

4

6}

Affiliations

¹ Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. kelchtermj@chop.edu.
² The Center of Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. kelchtermj@chop.edu.
³ Division of Pulmonary Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. kelchtermj@chop.edu.
⁴ The Center of Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
⁵ Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
⁶ Division of Pulmonary Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.

PMID: 37369742
PMCID: PMC10877545 (available on 2024-12-27)
DOI: 10.1038/s41370-023-00573-7

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, PM_2.5 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 PM_2.5 (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.

Keywords: Ambient air pollution; Asthma; Pediatric; Sensitivity.

Abstract

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