Associations between short-term exposure to fine particulate matter and acute exacerbation of asthma in Yancheng, China

doi:10.1016/j.chemosphere.2019.124497

Chemosphere

Volume 237, December 2019, 124497

https://doi.org/10.1016/j.chemosphere.2019.124497 Get rights and content

Highlights

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PM_2.5 was associated with increased risks of acute asthma exacerbation.
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Males and younger asthma patients were more susceptible to PM_2.5.
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Asthma patients were more sensitive to PM_2.5 in cold season.

Abstract

Scarce evidence existed on the association between short-term exposure to fine particulate matter (PM_2.5) and asthma in China. In this study, we aimed to explore the relationship of PM_2.5 with acute asthma exacerbation in a coastal city of China. Cases of acute asthma exacerbation were identified from hospital outpatient visits in Yancheng, China, from 2015 to 2018. We utilized the generalized additive model linked by a quasi-Poisson distribution to assess the association between PM_2.5 and daily acute asthma exacerbation. Different lag structures were built, and we conducted stratification analyses by gender, age, and season. Two-pollutant models were fitted, and concentration-response (C-R) curves were pooled. A total of 3,520 cases of acute asthma exacerbation were recorded, with a daily average of 3. We observed positive and significant associations of PM_2.5 on lag 1, 2, lag 02, and lag 03 day. For each 10-μg/m³ increase in PM_2.5 (lag 02), the associated increment in asthma was 3.15% (95% CI: 0.99%, 5.31%). The association remained after adjusting for gaseous co-pollutants. We observed significant PM_2.5-asthma associations in males, patients ≤64 years, and during cold seasons. The C-R curves were positive and almost linear for total and strata-specific associations. In conclusion, this study provided robust evidence on the association of PM_2.5 with acute asthma exacerbation, which may benefit future prevention strategy and policy making.

Graphical abstract

Introduction

Asthma, a common chronic inflammatory disease of the airways, is characterized by variable and recurring symptoms (i.e., wheezing, coughing, and breathlessness), reversible airflow obstruction, and easily triggered bronchospasms (Lin et al., 2014). In the Global Burden of Disease (GBD) report, the prevalence of asthma was 272.7 million in 2017, with an incidence of 43.1 million (GBD, 2018). The disease burden of asthma is also severe in China. According to an epidemiological survey in 2015, 17.4 million people (1.24% of the total population) were diagnosed with asthma (Su et al., 2014; Guan et al., 2016).

The hazardous impacts of air pollution on human health have been well documented (Jiang et al., 2016; Cox, 2017). Among air pollutants, fine particulate matter (PM_2.5, particles with aerodynamic diameters ≤ 2.5 μm) is of greater public health concern because it is capable of penetrating into the lungs and reaching the pulmonary alveolar region (Harrison and Yin, 2000; Kim et al., 2015). It has been suggested that PM_2.5 may exacerbate asthma symptoms and increase incidence risk of asthma (Bates et al., 2015; Deng et al., 2015; Matthews et al., 2016).

China is the largest developing country with high prevalence of asthma and some of the worst air quality levels. However, only a few epidemiological studies have examined the associations between PM_2.5 and outpatient visits of asthma (Jung et al., 2017; Tian et al., 2017), and there is less evidence regarding the endpoint of acute asthma exacerbation. Therefore, we designed this time-series study in Yancheng, one of the coastal cities in East China, to investigate the relationship between short-term exposure to PM_2.5 and acute asthma exacerbation.

Section snippets

Data collection

Yancheng is an emerging industrial and commercial city on the east coast of Jiangsu Province. It is located between 32°34 ′ to 34°28 ′ N and 119°27 ′ to 120°54′ E. The current study was limited to the urban areas, which hosted a target population of 1.0 million. The Gross Domestic Product (GDP) per capita in Yancheng was 76,000 Chinese Yuan in 2018.

Data on outpatient visits for asthma from November 1, 2015 to October 31, 2018 were obtained from 3 major hospitals in the urban area of Yancheng,

Descriptive results

A total of 3,520 cases (daily mean, 3 cases) of acute asthma exacerbation were included in this study. The male patients accounted for 49.5%, and 13.9% of participants were aged 65 or above. Descriptive statistics on acute asthma exacerbation, air pollutants, and meteorological factors during the study period are shown in Table 1. The average daily level of PM_2.5 was 42.8 μg/m³ (5.0–226.3 μg/m³). On average, the mean (±standard deviation) concentrations of NO₂, SO₂, O₃, CO, temperature, and

Discussion

In this time-series study in Yancheng, we observed positive and significant associations of short-term PM_2.5 exposure with acute asthma exacerbation. The associations were not insensitive to adjustment of co-pollutants in two-pollutant models. The overall C-R relationship curves were positive and almost linear in males, people in the ≤64 age group and during the cold season.

Air pollutants can have direct irritant and inflammatory effects on airway neuroreceptors and epithelium (Guarnieri and

Conclusions

To sum up, this study suggested a link of short-term exposure to PM_2.5 with acute asthma exacerbations in Yancheng, China. Novel evidence was provided on the different lag structures of the PM_2.5-asthma association and susceptible subgroups that may be more sensitive to PM_2.5 exposure. The association was generally robust to adjustment of co-pollutants. These findings indicated potential health benefits on reducing acute asthma exacerbations from lowering ambient PM_2.5 air pollution levels.

Conflicts of interest

The authors declared no conflicts of interests.

Acknowledgements

None.

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¹: These authors contributed equally to this work.

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Associations between short-term exposure to fine particulate matter and acute exacerbation of asthma in Yancheng, China

Highlights

Abstract

Graphical abstract

Introduction

Section snippets

Data collection

Descriptive results

Discussion

Conclusions

Conflicts of interest

Acknowledgements

Environ Res

Environ Res

Lancet

Lancet

Sci Total Environ

Environ Pollut

Environ Int

Sci Total Environ

Environ Health

Environ Pollut

Environ Pollut

Reactive oxygen species generation linked to sources of atmospheric particulate matter and cardiorespiratory effects

Environ Sci Technol

Fine particulate air pollution and hospital admissions for asthma: a case-crossover study in Taipei

J Toxicol Environ Health A

A growing role for gender analysis in air pollution epidemiology

Environ Health Perspect