Urban air pollution and emergency admissions for asthma in four European cities: the APHEA Project

Abstract

Asthma morbidity has been increasing for Background -A study was undertaken to reasons not yet well understood.1 Although assess the combined association between evidence for an increasing incidence of asthma urban air pollution and emergency ad-due to air pollution has not been provided, air missions for asthma during the years pollution could exacerbate existing asthma. to sulphur dioxide (SO 2 ), ozone (O 3 ), and Methods -Daily counts were made of nitrogen dioxide (NO 2 ) at levels compatible asthma admissions and visits to the emer-with urban life produced bronchial hypergency room in adults (age range 15-64 responsiveness and inflammation and reduced years) and children (<15 years). Covari-the dose of aeroallergen needed to produce ates were short term fluctuations in tem-a given bronchial response.3-9 Studies on air perature and humidity, viral epidemics, pollution in laboratory face two main limday of the week effects, and seasonal and itations: the non-representative selection of secular trends. Estimates from all the cities subjects and the simplification of human exwere obtained for the entire period and posures. separately by warm or cold seasons using Some recent population studies have related Poisson time-series regression models. daily levels of particles and ozone to the increase Combined associations were estimated of emergency room admissions for asthma, using meta-analysis techniques.though these findings do not extend to all Results -Daily admissions for asthma in the studies.2 10 Epidemiological studies on daily adults increased significantly with in-variations in asthma admissions and air polcreasing ambient levels of nitrogen dioxide lution levels assess the general population at (NO 2 ) (relative risk (RR) per 50 g/m 3 in-real world exposures with adequate internal crease 1.029, 95% CI 1.003 to 1.055) and validity.11 12 The APHEA Project 13 is an internon-significantly with particles measured national European prospective standardised as black smoke (RR 1.021, 95% CI 0.985 to study on the short term health effects of air 1.059). The association between asthma pollution in the general population. This paper admissions and ozone (O 3 ) was hetero-combines the individual city associations of air geneous among cities. In children, daily pollution with asthma admissions in Barcelona, admissions increased significantly with Helsinki, London and Paris, the four European sulphur dioxide (SO 2 ) (RR 1.075, 95% CI cities in APHEA that collected data on asthma. 1.026 to 1.126) and non-significantly with This multi-city study allows an evaluation of a black smoke (RR 1.030, 95% CI 0.979 to wide variability in environmental exposures and 1.084) and NO 2 , though the latter only in enhances the external validity of findings. cold seasons (RR 1.080, 95% CI 1.025 to Individual results have been reported for 1.140). No association was observed for O 3 . Helsinki 14 and Barcelona.

Air pollution, avoidance behaviour and children's respiratory health: Evidence from England

“…Examining asthma hospitalisations between March and October, Neidell (2009) (1996), Atkinson et al (1999) and Anderson et al (2001) Leon et al (1996), Sunyer et al (1997), Petroeschevsky et al (2001), Burnett et al (1994) and Fusco et al (2001) find elasticities at the mean between 0.004 and 0.06, up to two-thirds of my estimates. These studies assign one air pollution measure to the whole study area, so their estimates suffer from measurement error.…”

“…Sunyer et al (1997) investigate the relationship between air pollution and children's asthma admissions in Helsinki, London and Paris. They compute a combined estimate across cities by taking the weighted average of the city-specific coefficients using inverse variance weights.…”

Air pollution, aeroallergens and cardiorespiratory emergency department visits in Saint John, Canada

“…No other pollutants were considered in this study. In a later meta -analysis of asthma ED visit studies in Barcelona, Helsinki, London and Paris, Sunyer et al (1997 ) found positive and significant effects of NO 2 among adults, and of SO 2 among children, both of which remained unchanged when adjusted for BS. Effects of ozone were heterogeneous among cities for adults, with no effect in children, and the effect of BS was positive but not significant for both adults and children.…”

Associations between ambient air pollution and daily emergency department attendances for cardiovascular disease in the elderly (65+ years), Sydney, Australia

“…Acute effects of ambient air pollution on mortality and hospital admissions have been well documented in both Australia and elsewhere (Simpson et al, 1997(Simpson et al, , 2000Sunyer et al, 1997;Morgan et al, 1998a, b;Spix et al, 1998;Kunzli et al, 1999;Schwartz, 1999;Samet et al, 2000;Pope et al, 2002). Fewer studies have investigated associations between ambient air pollutants and emergency department (ED) attendances and the majority of these have reported on the associations between air pollution and ED attendances for asthma (Schwartz et al, 1993;Castellsague et al, 1995;Smith et al, 1996;Stieb et al, 1996;Tenias et al, 1998;Fauroux et al, 2000).…”