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The effect of short-term particular matter2.5 exposure on asthma attacks in asthma children in Fukuoka, Japan

Article information

Kosin Med J. 2018;33(2):171-180
Publication date (electronic) : 2018 January 19
doi : https://doi.org/10.7180/kmj.2018.33.2.171
Song Han Lee,1, Koh Woon Lee1, Yoon Ha Hwang1, Hiroshi Odajima2
1Department of Pediatrics, Busan St. Mary’s Hospital, Busan, Korea
2Department of Pediatrics, Fukuoka National Hospital, Japan, Korea
Corresponding Author: Lee Song Han, Department of Pediatrics, Busan St. Mary’s Hospital 25-14, Yongho-ro, 232 beon-gil, Nam-gu, Busan 48575, Korea Tel: +82-52-246-6113 Fax: +82-52-246-6113 E-mail: thdgks33@naver.com
Received 2016 September 21; 2016 October 20; Accepted 2016 October 24.

Abstract

Objectives

We investigated whether asthma attacks in asthmatic children were caused by short-term exposure to particulate matter(PM)2.5.

Methods

Subjects were 411 patients who received inhalation therapy in National Fukuoka Hospital, from March to May 2013. All subjects were outpatients. We surveyed the air quality measurement results in the stations closest to the address of the patients. Data were used from the City of Fukuoka website data on air pollution. We carried out a case-crossover study and compared PM2.5 concentration between 7 days after asthma attack occurred and the day asthma attack occurred and 1, 2 and 3 days before asthma attack occurred.

Results

Highest hourly concentration of the day (OR 1.013, 95%CI 1.000-1.025) showed a significant association with 1 day before PM2.5 concentration statistically. And 0-1 year-old infants were more vulnerable to the highest concentration of 1 day before PM2.5 concentration(P < 0.05). Average concentration of NO2 and O3 and asthma attack also showed a significant association.

Conclusions

Maximal daily PM2.5 concentrations within 24 hours prior to the attack affect asthma exacerbation. 0-1 year-old infants are particularly vulnerable to PM2.5 concentration. Asthma exacerbation is aggravated by NO2 and O3 concentration on the day of the asthma attack.

Keywords: Air pollution; Asthma; Asthma attack; Japan
Fig. 1.

Map of monitoring stations in Fukuoka. The table on the left shows the names of monitoring stations, the number of asthma patients, and percentage.

Characteristics of the study groups.

Comparison of maximal, average concentration of PM2.5 (μg/㎥).

Odds ratios and 95% confidence intervals of asthma attack by maximal 1-hour concentration of each air pollutant.

Odds ratios and 95% confidence intervals of asthma attack by average daily concentration of each air pollutant.

Odds ratios and 95% confidence intervals of asthma attack by maximal 1-hour concentration of PM2.5 divided by age group.

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Copyright © 2018 Kosin University School of Medicine Proceedings

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Fig. 1.

Fig. 1.

Map of monitoring stations in Fukuoka. The table on the left shows the names of monitoring stations, the number of asthma patients, and percentage.

Table 1.

Characteristics of the study groups.

Number Percent
Total 411
Sex ratio (M:F) 1.45
Mean age(± SD) 5.58 ± 4.41
Age
0-1 97 23.6
2-5 142 34.5
6-12 136 33.1
13-15 30 7.3
Over 16 6 1.5

Table 2.

Comparison of maximal, average concentration of PM2.5 (μg/㎥).

D-3‡ Control day D-2§ Control day
Average(maximal) 35.65 36.50 35.52 33.91
Standard deviation 18.53 19.34 18.73 16.81
P 0.522 0.196
D-1∥ Control day D0 Control day
Average(maximal) 35.44 32.84 35.71 34.53
Standard deviation 18.22 15.63 18.19 18.23
P 0.029 0.352
D-3‡ Control day D-2§ Control day
Average(average) 22.21 22.92 21.81 21.47
Standard deviation 12.33 13.98 11.54 12.64
P 0.439 0.684
D-1∥ Control day D0 Control day
Average(average) 21.34 19.81 21.95 21.17
Standard deviation 11.89 11.00 13.06 12.43
P 0.057 0.382
*

P < 0.01

†

P < 0.05 by t-test

‡

D-3 : 3 days prior to day of attack

§

D-2 : 2 days prior to day of attack

∥

D-1 : 1 day prior to day of attack

D0 : day of asthma attack

Table 3.

Odds ratios and 95% confidence intervals of asthma attack by maximal 1-hour concentration of each air pollutant.

D-3‡ D-2§
OR* 95%CI† P OR* 95%CI† P
PM2.5 Single-variant 0.998 0.990-1.005 0.522 1.005 0.997-1.013 0.196
Multi-variant 0.841 0.719-0.983 0.030 0.932 0.844-1.029 0.165
SPM Single-variant 0.993 0.986-1.000 0.067 0.998 0.990-1.006 0.579
Multi-variant 1.160 1.037-1.297 0.009 1.060 0.981-1.146 0.142
NO2 Single-variant 1.004 0.988-1.021 0.615 1.013 0.997-1.029 0.105
Multi-variant 0.973 0.885-1.069 0.564 1.101 1.012-1.197 0.026
O3 Single-variant 0.984 0.971-0.997 0.197 0.986 0.972-0.999 0.042
Multi-variant 1.174 1.089-1.264 0.000 1.043 0.995-1.094 0.081
D-1∥ D0
OR* 95%CI† P OR* 95%CI† P
PM2.5 Single-variant 1.009 1.001-1.017 0.030 1.004 0.996-1.011 0.352
Multi-variant 1.063 0.944-1.195 0.313 0.954 0.874-1.040 0.286
SPM Single-variant 1.004 0.996-1.012 0.318 1.002 0.995-1.009 0.598
Multi-variant 0.992 0.903-1.090 0.874 1.027 0.968-1.090 0.380
NO2 Single-variant 1.016 1.000-1.033 0.052 1.010 0.995-1.026 0.197
Multi-variant 1.001 0.922-1.086 0.984 1.111 0.944-1.308 0.207
O3 Single-variant 1.003 0.988-1.019 0.661 1.015 0.999-1.030 0.065
Multi-variant 0.920 0.860-0.985 0.016 1.011 0.965-1.056 0.646
*

OR : odds ratio

†

CI : confidence interval

‡

D-3 : 3 days prior to day of attack

§

D-2 : 2 days prior to day of attack

∥

D-1 : 1 day prior to day of attack

D0 : day of asthma attack

Table 4.

Odds ratios and 95% confidence intervals of asthma attack by average daily concentration of each air pollutant.

D-3‡ D-2§
OR* 95%CI† P OR* 95%CI† P
PM2.5 Single-variant 0.996 0.986-1.006 0.439 1.002 0.991-1.014 0.683
Multi-variant 0.777 0.564-1.072 0.124 1.052 0.880-1.257 0.581
SPM Single-variant 0.992 0.981-1.002 0.133 0.994 0.983-1.005 0.304
Multi-variant 1.299 0.963-1.752 0.086 0.977 0.854-1.117 0.729
NO2 Single-variant 0.993 0.961-1.027 0.692 1.013 0.978-1.049 0.467
Multi-variant 0.815 0.601-1.103 0.185 1.271 1.027-1.572 0.027
O3 Single-variant 1.006 0.989-1.024 0.481 0.994 0.975-1.013 0.513
Multi-variant 1.475 1.179-1.846 0.001 1.128 1.031-1.234 0.009
D-1∥ D0
OR* 95%CI† P OR* 95%CI† P
PM2.5 Single-variant 1.012 1.000-1.024 0.057 1.005 0.994-1.016 0.382
Multi-variant 1.068 0.907-1.259 0.430 1.004 0.893-1.129 0.941
SPM Single-variant 1.009 0.997-1.020 0.133 1.004 0.993-1.014 0.506
Multi-variant 0.952 0.835-1.085 0.456 0.974 0.894-1.063 0.558
NO2 Single-variant 1.018 0.985-1.052 0.299 1.034 1.002-1.068 0.040
Multi-variant 1.078 0.926-1.255 0.331 1.103 0.942-1.292 0.224
O3 Single-variant 1.016 0.997-1.035 0.097 1.031 1.012-1.050 0.001
Multi-variant 1.037 0.960-1.120 0.359 1.058 0.990-1.131 0.098
*

OR : odds ratio

†

CI : confidence interval

‡

D-3 : 3 days prior to day of attack

§

D-2 : 2 days prior to day of attack

∥

D-1 : 1 day prior to day of attack

D0 : day of asthma attack

Table 5.

Odds ratios and 95% confidence intervals of asthma attack by maximal 1-hour concentration of PM2.5 divided by age group.

Age group (years) Odds ratio 95% Confidence interval P-value
0-1 1.018 1.001-1.035 0.042
2-5 1.002 0.988-1.017 0.757
6-12 1.007 0.993-1.021 0.345
13-15 1.022 0.993-1.052 0.139
Over 16 0.987 0.879-1.108 0.822