Abstract
Background: Few case-control studies of time dependent environmental exposures and respiratory outcomes have been performed. Small sample sizes pose modeling challenges for estimating interactions. In contrast, case cross-over studies are well suited where control selection and responses are low, time consuming and costly. Objective: To demonstrate feasibility in daily recruitment of children admitted to hospital with asthma and validity of the case crossover methodology for hospital based studies. Methods: The Melbourne Air Pollen Children and Adolescent Health (MAPCAH) study recruited incident asthma admissions of children and adolescents aged 2–17 years to a tertiary hospital. A case was defined by date of admission, and eligible cases served as their own controls. We used bi-directional sampling design for control selection. At time of admission, participants underwent skin prick tests and nasal/throat swabs (NTS) to test for respiratory viruses. Questionnaires collected data on asthma management, family history and environmental characteristics. Daily concentrations of ambient pollen, air pollution and weather variables were also available. Results: 644 children were recruited. More than half (63%) were male with mean age 5.2(SD 3.3) years. Non-participants were slightly younger at admission (mean age 4.4, SD 2.8, p<0.001), although the absolute differences were small. Participants and non-participants were well balanced on gender. The most common reason for refusal to participate in the study was “causing further distress to child by skin prick testing”. Gender and age distributions were similar to the overall admissions to the tertiary hospital as well as in Victoria. Our study slightly under-represented winter admissions (p<0.001), and was over-represented in spring (p<0.001). More admissions occurred during the grass pollen season in our study than in general asthma hospital admissions across Victoria (42% versus 22%, p<0.001). Conclusions: The case cross-over method is a highly feasible design for a reasonably sized hospital based study of children with asthma. MAPCAH has robust internal validity and strong generalizability. Collection of data on respiratory viruses and pollen exposure at the time of admission on children with asthma provides important information that will have clinical and public health impacts.
Highlights
In Australia, UK and the US, asthma is the leading long term health condition in children aged 0 to 15 years [1,2,3]
More admissions occurred during the grass pollen season in our study than in general asthma hospital admissions across Victoria (42% versus 22%, p
Children with asthma will be at the most risk, as they are more susceptible to abrupt changes in the environment, resulting in sudden peaks in hospital admissions [11]
Summary
In Australia, UK and the US, asthma is the leading long term health condition in children aged 0 to 15 years [1,2,3]. The commonest factors that trigger exacerbations in children are environmental, such as pollen exposure [Erbas et al, 2012 under review], air pollution [7], viral respiratory infections [8], and abrupt changes in weather, such as thunderstorm-related asthma [9,10]. Most studies, including our own prior work, have used aggregated daily time series data at the population level to examine associations between outdoor pollen and asthma morbidity [7,12,13]. These studies have limited applicability, because they do not have access to individual clinical data such as asthma severity, the presence of respiratory viral infections and data on family history. Case cross-over studies are well suited where control selection and responses are low, time consuming and costly
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
