Air pollution indicators predict outbreaks of asthma exacerbations among elementary school children: integration of daily environmental and school health surveillance systems in Pennsylvania

Abstract

Objectives of this study are to determine if a relationship exists between asthma exacerbations among elementary school children in industrialized countries (with climatic seasons) and exposure to daily air pollution with particulate matter, sulfur dioxide, nitrogen dioxide, nitrogen oxides, carbon monoxide, and ozone, when controlled for potential confounders; and, if so, to derive a statistical model that predicts variation of asthma exacerbations among elementary school children. Using an ecological study design, health records of 168,25 students from elementary schools in 49 Pennsylvania counties employing "Health eTools for Schools" were analyzed. Asthma exacerbations were recorded by nurses as treatment given during clinic visits each day. Daily air pollution measurements were obtained from the EPA's air quality monitoring sites. The distribution of asthmatic grouping for pollen and calendar seasons was developed. A Poisson regression model was used to predict the number of asthma exacerbations. The greatest occurrence of asthma exacerbations was in autumn, followed by summer, spring and winter. If the number of asthma exacerbations on a day is N and the daily mean of asthma exacerbations for the three-year period is 48, the probabilities of N > 48 in tree pollen and grass pollen seasons were 56.5% and 40.8%, respectively (p < 0.001). According to the Poisson regression, the week number and prior day CO, SO₂, NO₂, NOx, PM₂.₅, and O₃ had significant effects on asthma exacerbations among students. Monitoring of air pollutants over time could be a reliable new means for predicting asthma exacerbations among elementary school children. Such predictions could help parents and school nurses implement effective precautionary measures.

Machine learning approaches to personalize early prediction of asthma exacerbations

“…31 Current prediction rules for asthma exacerbations use a variety of predisposing factors, including genes, 32 inflammatory biomarkers, 33,34 airway function, 35,36 symptom scores, 36,37 medication use, 38 urgent-care utilization patterns, 39 and environmental factors. 40 However, most of these rules identify who is more likely to experience an asthma attack, rather than when an asthma attack is about to occur. Although identifying individuals with a high risk of developing asthma exacerbations is important because it allows medical care providers to focus on patients who need higher levels of service, it is insufficient for ensuring timely intervention before acute exacerbations occur.…”

Persistence of Serotonergic Enhancement of Airway Response in a Model of Childhood Asthma

“…In the O 3 Addition of the 5-HT 1A receptor agonist 8-OH-DPAT significantly attenuated EFS-induced ASM contraction in a concentration-dependent manner ( Figure 5A). This effect was seen in both the FA and O 3 1 HDMA groups, indicating that exposure had no effect.…”

“…Although the mechanisms responsible for asthma symptoms are debatable, research shows that O 3 and HDMA exposure leads to functional, structural, neural, vascular, and immunological alterations in airways (10)(11)(12)(13)(14)(15)(16). This airway remodeling indicates that environmental insults early in life can have life-long deleterious effects on lung function and may lead to chronic asthma symptoms.…”

“…The presence of AHR after O 3 and HDMA exposure indicates that airway function has been compromised. In humans, nonhuman primates, and other models of asthma, O 3 and HDMA exposure has been shown to increase AHR (18)(19)(20)(21).…”

“…The link between ozone (O 3 ) and house dust mite allergen (HDMA) exposure and childhood asthma has been supported by a wealth of research (3)(4)(5)(6)(7)(8)(9). In the latest State of the Air report, almost half of United States citizens-over 148 million people-live in areas with unhealthy O 3 levels (6).…”