200 grains/m ofPoaceae, and between 10 and 15 grains/m of Urticaceae. The use of nonparametric methods provided more informative estimations than traditional linear approaches for continuous environmental factors. The advantage of this innovative approach is that we do not need to make any a priori assumption about the functional form of the relationship. In comparison with categorical analyses, this method can be more efficient (3), also removing the need to select cut-off points for categories in an opportunistic manner. We observed evident nonlinearities for the estimated relationships between airborne pollen levels with allergenic capacity and risk of asthma emergency room admissions, updating our previous results (5) and being similar to those described for grass pollen in England (6). Note that GAMs are very conservative at the extremes of the curve, having wide confidence intervals, as the Fig. 1 shows. This is because usually there are few observations at the extremes of the exposure factor, and because of a slight boundary effect inherent in all flexible methods. Furthermore, results can be presented only in relation to a reference category. Then a graphical distortion can lead to misinterpretations as well as the arbitrary selection of the reference point (3). However, the highest risk of asthma morbidity in Madrid was that related to the highest airborne pollen levels when abruptly released into Madrid s environment. This study was funded by the Advisory Committee to the Madrid Regional Asthma Prevention & Control Programme (Comision Asesora del Programa Regional de Prevencion y Control del Asma de la Comunidad de Madrid). Aurelio Tobias had a postgraduate fellowship of Universidad Autonoma de Madrid. Marc Saez was partially funded by Fondo de Investigacion Sanitaria, FIS 00/0010–02.
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