Asthma Emergency Department Visits Research Articles

Emergency Department Visit Count: A Practical Tool to Predict Asthma Hospitalization in Children

To evaluate whether the frequency of asthma-related emergency department (ED) visits could predict future asthma hospitalization in the pediatric population.The study included 2669 children between the ages of 2 and 16.99 years with asthma visits to the ED at the Children’s Hospital of Eastern Ontario between September 2012 to August 2015.This was a retrospective cohort study in which health administrative data were used to identify all pediatric asthma visits to the ED from 2012 to 2015. The first asthma ED visit within the 3-year inclusion period was defined as index ED visit. The primary exposure was the number of asthma ED visits in the preceding 12 months. Each patient was managed for 12 months after the index ED visit to identify the number of asthma-related hospitalizations and subsequent ED visits. The severity of asthma symptoms at each visit was assessed by using the Canadian Triage and Acuity Scale.The number of asthma ED visits in the preceding year was associated with an increased risk of hospitalization in the subsequent 12 months in a dose-dependent manner. The risk of hospitalization was 2.9 (95% confidence interval: 1.6 to 5) times higher in children with 1 previous ED visit and 4.4 (95% confidence interval: 1.9 to 10.4) times higher in children with ≥2 previous ED visits, compared with that of children with no ED visits. Asthma severity on the basis of Canadian Triage and Acuity Scale level was also a risk factor for future asthma hospitalization. The number of previous asthma ED visits was associated with an increased risk of repeat asthma ED visits in the following year.The number of asthma ED visits was identified as an independent marker of future asthma-related hospitalizations and repeat ED visits in pediatric patients.A major goal of asthma management is to reduce the risk of exacerbations leading to ED visits and hospitalization. Poor asthma control leads to school absenteeism and increased health care use. Identification of a reliable marker to predict future asthma risk could help health care providers target interventions to children at high risk. In this study, the authors identified ED visit count as a predictor of future asthma-related hospitalization in pediatric patients.

Machine learning-driven identification of early-life air toxic combinations associated with childhood asthma outcomes.

Air pollution is a well-known contributor to asthma. Air toxics are hazardous air pollutants that cause or may cause serious health effects. Although individual air toxics have been associated with asthma, only a limited number of studies have specifically examined combinations of air toxics associated with the disease. We geocoded air toxic levels from the US National Air Toxics Assessment (NATA) to residential locations for participants of our AiRway in Asthma (ARIA) study. We then applied Data-driven ExposurE Profile extraction (DEEP), a machine learning-based method, to discover combinations of early-life air toxics associated with current use of daily asthma controller medication, lifetime emergency department visit for asthma, and lifetime overnight hospitalization for asthma. We discovered 20 multi-air toxic combinations and 18 single air toxics associated with at least 1 outcome. The multi-air toxic combinations included those containing acrylic acid, ethylidene dichloride, and hydroquinone, and they were significantly associated with asthma outcomes. Several air toxic members of the combinations would not have been identified by single air toxic analyses, supporting the use of machine learning-based methods designed to detect combinatorial effects. Our findings provide knowledge about air toxic combinations associated with childhood asthma.

Evaluation of a pediatric asthma high-risk scoring algorithm.

Identification of patients with asthma at increased risk for hospitalization and emergency department (ED) visits presents opportunity for intervention. Retrospective analysis of computerized health plan claims data. Texas Children's Health Plan, a large Medicaid managed care program, developed an asthma risk scoring algorithm using the clinically relevant parameters of hospitalization for asthma, ED visits for asthma, short-acting β agonist medication dispensing, inhaled corticosteroid medication dispensing, number of prescribing providers, loss to follow-up, and oral corticosteroid dispensing. The risk score performance was evaluated using 2016-2018 risk scores to predict 2017-2019 asthma hospitalizations and ED visits. We identified 107,811 unique members aged 1 to less than 18 years with an asthma diagnosis. For those aged 3 to less than 18 years, the area under the receiver operating characteristic curve (AUC) for risk score predicting hospitalization ranged from 0.72 to 0.79. For those aged 1 to less than 3 years, the AUC ranged from 0.65 to 0.69. Those with a risk score of 1 or greater accounted for 20% to 23% of pediatric members 3 to less than 18 years with asthma but 53% to 56% of asthma hospitalizations in the follow-up year. Sixteen to eighteen percent of those aged 3 to less than 18 years with a risk score of 9 or greater were hospitalized in the follow-up year. Texas Children's Health Plan asthma risk score stratifies risk of asthma hospitalization and ED visits for Medicaid-insured children. The risk score performs better for children aged 3 to less than 18 years than for those aged 1 to less than 3 years.

Concurrent asthma and chronic obstructive pulmonary disease in adult ED patients: A national perspective.

Emergency department (ED) visits for Asthma and Chronic Obstructive Pulmonary Disease (COPD) are common. The designation of Asthma-COPD overlap (ACO) has been used to describe patients with features of both diseases. Studies show that ACO patients may be at increased risk of poor outcomes relative to patients with either disease alone. We sought to characterize ED visits and ED-related outcomes of patients with ACO compared to patients with Asthma or COPD alone. We conducted a secondary analysis of the National Hospital Ambulatory Medical Care Survey (NHAMCS, 2005-2018) characterizing ED visits in patients ≥35 years of age with Asthma Only, COPD Only or ACO. We performed univariable and multivariable analyses adjusting for demographics to assess relevant ED outcome variables. From 2005 to 2018, there were an estimated 8.15, 17.78 and 0.56 million ED visits for Asthma Only, COPD Only and ACO, respectively. ACO patients were younger than COPD Only patients (mean age 50.18 versus 61.79; p < 0.001). ACO patients differed in terms of sex, race and ethnicity from patients with either disease alone. When triaged, Asthma Only (adjusted odds ratio (aOR) = 11.45; 95% confidence interval (CI), 1.20-109.38) patients were more likely to require immediate care than ACO patients. Although admission rates were comparable between groups, ACO patients had a decreased mean length of ED visit compared to both Asthma Only (p < 0.001) and COPD Only (p < 0.05) patients. COPD Only patients were less likely than ACO patients to be seen in the ED in the last 72 h (aOR = 0.22; 95% CI, 0.056-0.89), receive nebulizer therapy (aOR = 0.55; 95% CI, 0.31-0.97), bronchodilators (aOR = 0.24; 95% CI, 0.12-0.48) and systemic corticosteroids (aOR = 0.18; 95% CI, 0.091-0.35). Asthma Only patients were less likely than ACO patients to undergo any imaging (aOR = 0.55; 95% CI, 0.31-0.96) and receive antibiotics (aOR = 0.46; 95% CI, 0.23-0.93). ACO patients appear to differ demographically from patients with either disease alone in the ED. After adjustment for these demographic differences, ACO patients appear to differ with respect to several ED variables, notably respiratory therapies; however, clinical outcomes including admission and mortality rates appear to be comparable between groups.

Estimating Intra-Urban Inequities in PM2.5-Attributable Health Impacts: A Case Study for Washington, DC.

Air pollution levels are uneven within cities, contributing to persistent health disparities between neighborhoods and population sub‐groups. Highly spatially resolved information on pollution levels and disease rates is necessary to characterize inequities in air pollution exposure and related health risks. We leverage recent advances in deriving surface pollution levels from satellite remote sensing and granular data in disease rates for one city, Washington, DC, to assess intra‐urban heterogeneity in fine particulate matter (PM2.5)‐ attributable mortality and morbidity. We estimate PM2.5‐attributable cases of all‐cause mortality, chronic obstructive pulmonary disease, ischemic heart disease, lung cancer, stroke, and asthma emergency department (ED) visits using epidemiologically derived health impact functions. Data inputs include satellite‐derived annual mean surface PM2.5 concentrations; age‐resolved population estimates; and statistical neighborhood‐, zip code‐ and ward‐scale disease counts. We find that PM2.5 concentrations and associated health burdens have decreased in DC between 2000 and 2018, from approximately 240 to 120 cause‐specific deaths and from 40 to 30 asthma ED visits per year (between 2014 and 2018). However, remaining PM2.5‐attributable health risks are unevenly and inequitably distributed across the District. Higher PM2.5‐attributable disease burdens were found in neighborhoods with larger proportions of people of color, lower household income, and lower educational attainment. Our study adds to the growing body of literature documenting the inequity in air pollution exposure levels and pollution health risks between population sub‐groups, and highlights the need for both high‐resolution disease rates and concentration estimates for understanding intra‐urban disparities in air pollution‐related health risks.

Associations of Air Pollution and Pediatric Asthma in Cleveland, Ohio

Air pollution has been associated with poor health outcomes and continues to be a risk factor for respiratory health in children. While higher particulate matter (PM) levels are associated with increased frequency of symptoms, lower lung function, and increase airway inflammation from asthma, the precise composition of the particles that are more highly associated with poor health outcomes or healthcare utilization are not fully elucidated. PM is measured quantifiably by current air pollution monitoring systems. To better determine sources of PM and speciation of such sources, a particulate matter (PM) source apportionment study, the Cleveland Multiple Air Pollutant Study (CMAPS), was conducted in Cleveland, Ohio, in 2009–2010, which allowed more refined assessment of associations with health outcomes. This article presents an evaluation of short-term (daily) and long-term associations between motor vehicle and industrial air pollution components and pediatric asthma emergency department (ED) visits by evaluating two sets of air quality data with healthcare utilization for pediatric asthma. Exposure estimates were developed using land use regression models for long-term exposures for nitrogen dioxide (NO2) and coarse (i.e., with aerodynamic diameters between 2.5 and 10 μm) particulate matter (PM) and the US EPA Positive Matrix Factorization receptor model for short-term exposures to fine (<2.5 μm) and coarse PM components. Exposure metrics from these two approaches were used in asthma ED visit prevalence and time series analyses to investigate seasonal-averaged short- and long-term impacts of both motor vehicles and industry emissions. Increased pediatric asthma ED visits were found for LUR coarse PM and NO2 estimates, which were primarily contributed by motor vehicles. Consistent, statistically significant associations with pediatric asthma visits were observed, with short-term exposures to components of fine and coarse iron PM associated with steel production. Our study is the first to combine spatial and time series analysis of ED visits for asthma using the same periods and shows that PM related to motor vehicle emissions and iron/steel production are associated with increased pediatric asthma visits.

Neighborhood-level variability in asthma-related emergency department visits in Central Texas

The extent to which asthma-related emergency department (ED) visit incidence rates vary from neighborhood to neighborhood and the predictors of neighorbood-level asthma ED visit burden are not well understood. Our aim was to describe the census tract-level spatial distribution of asthma-related ED visits in Central Texas and identify neighborhood-level characteristics that explain variability in neighborhood-level asthma ED visit rates. Conditional autoregressive models were used to examine the spatial distribution of asthma-related ED visit incidence rates across Travis County, Texas, census tracts and to assess the contribution of census tract characteristics to their distribution. There were distinct patterns in ED visit incidence rates at the census tract scale that were largely unexplained by socioeconomic or selected built environment neighborhood characteristics. Racial and ethnic composition explained 33% of the variability of ED visit incidence rates across census tracts. Spatial patterns and the census tract predictors of ED visit incidence rates differed by racial and ethnic groups. Variability in asthma ED visit incidence rates areapparent at smaller spatial scales than previously examined.Most of the variability in census tract-level asthma ED visitrates in Central Texas is not explained by racial andethniccomposition or other neighborhood features. Race/ethnicity-specific estimates of neighborhood ED visit rates may be useful for identifying high-burden neighborhoods for specific ethnic and racial groups that otherwise would go unrecognized.

Fine particulate matter constituents associated with emergency room visits for pediatric asthma: a time-stratified case\u2013crossover study in an urban area

BackgroundGlobal asthma-related mortality tallies at around 2.5 million annually. Although asthma may be triggered or exacerbated by particulate matter (PM) exposure, studies investigating the relationship of PM and its components with emergency department (ED) visits for pediatric asthma are limited. This study aimed to estimate the impact of short-term exposure to PM constituents on ED visits for pediatric asthma.MethodsWe retrospectively evaluated non-trauma patients aged younger than 17 years who visited the ED with a primary diagnosis of asthma. Further, measurements of PM with aerodynamic diameter of < 10 μm (PM10), PM with aerodynamic diameter of < 10 μm (PM2.5), and four PM2.5 components (i.e., nitrate (NO3−), sulfate (SO42−), organic carbon (OC), and elemental carbon (EC)) were collected between 2007 and 2010 from southern particulate matter supersites. These included one core station and two satellite stations in Kaohsiung City, Taiwan. A time-stratified case-crossover study was conducted to analyze the hazard effect of PM.ResultsOverall, 1597 patients were enrolled in our study. In the single-pollutant model, the estimated risk increase for pediatric asthma incidence on lag 3 were 14.7% [95% confidence interval (CI), 3.2–27.4%], 13.5% (95% CI, 3.3–24.6%), 14.8% (95% CI, 2.5–28.6%), and 19.8% (95% CI, 7.6–33.3%) per interquartile range increments in PM2.5, PM10, nitrate, and OC, respectively. In the two-pollutant models, OC remained significant after adjusting for PM2.5, PM10, and nitrate. During subgroup analysis, children were more vulnerable to PM2.5 and OC during cold days (< 26 °C, interaction p = 0.008 and 0.012, respectively).ConclusionsBoth PM2.5 concentrations and its chemical constituents OC and nitrate are associated with ED visits for pediatric asthma. Among PM2.5 constituents, OC was most closely related to ED visits for pediatric asthma, and children are more vulnerable to PM2.5 and OC during cold days.

Using Bayesian time-stratified case-crossover models to examine associations between air pollution and “asthma seasons” in a low air pollution environment

BACKGROUND AND AIM: Many areas of the United States have air pollution levels typically below Environmental Protection Agency (EPA) regulatory limits. However, despite evidence suggesting temporally-misaligned intra-annual periods of relative asthma burden, “asthma seasons”, most studies of the health effects of air pollution use meteorological (e.g., warm/cool) or astronomical (e.g., solstice/equinox) definitions of seasons. We introduce asthma seasons to elucidate whether air pollutants were associated with seasonal differences in asthma emergency department (ED) visits in a low air pollution environment. METHODS: Within a Bayesian time-stratified case-crossover framework, we quantified associations between highly resolved estimates of six criteria air pollutants and asthma ED visits among 66,092 children ages 5-19 living in South Carolina (SC) census tracts over 2005-2014. Asthma seasons were defined by a late, short, and medium burden (16.5 visits/day) Winter, an early and short Spring with medium-high burden (18.9 visits/day), an early and low burden (9.4 visits/day) Summer, and an early and long Fall with high burden (23.5 visits/day). RESULTS:Coarse particulates (particulate matter 10μm and 2.5μm: PM10-2.5) and nitrogen oxides (NOx) may contribute to asthma ED visits across years, but were particularly implicated in the highest burden Fall. Allergenic antigens of respirable size from Fall-blooming plants (e.g., ragweed) should be further investigated as a potentially salient seasonal PM10-2.5 component. Fine particulate matter (2.5μm: PM2.5) was only associated in the lowest-burden Summer. Relatively cool and dry conditions in the Summer often following thunderstorms were associated with increased odds. Few significant associations in the medium-burden Winter and Spring suggest other drivers (e.g., viruses in Winter) for each, respectively. CONCLUSIONS:Even in a low pollution area, there were acute health effects associated with criteria air pollution, but mainly in the Summer and Fall asthma seasons. Future research should explicitly investigate local asthma seasons as well as the seasonal components of PM and other mixtures. KEYWORDS: asthma, allergies, air pollution, particulate matter, respiratory outcomes, environmental epidemiology

Inhaled corticosteroid prescriptions in the ED for recurrent asthma using IT clinical decision support: revisit after cessation of an incentive program

Introduction The objective of this study was to assess whether inhaled corticosteroid (ICS) prescription rates for patients with poorly controlled asthma presenting to the emergency department (ED) remained high with a clinical support system in place, after a financial incentive program ended. This study is the second phase of a previous study done at our institution. The first phase demonstrated that the introduction of an electronic alert system advising providers to prescribe ICS to patients with poorly controlled asthma, along with a financial incentive, increased ICS prescription rates from 2% to 77%. Clinical support systems are necessary to improve control for patients with asthma, as prescribing ICS in the ED has not previously been standard of care. Methods This retrospective study identified 96 eligible patients during the study period of January 1, 2019 to December 31, 2019. Subjects included patients aged 4–18 with at least two ED visits for asthma within 365 days and no recent ICS prescription. For subjects meeting these criteria, an electronic alert activated, advising the provider to prescribe ICS. Results ICS prescription rate without the incentive remained high at 0.74 (0.59, 0.86) and was not significantly different than the rate with the incentive of 0.77 (0.65, 0.87), with p value 0.82. No significant differences were detected in baseline characteristics between patients discharged with and without an ICS prescription. Conclusions This study confirmed that an electronic alert advising ICS prescription in the ED for patients with recurrent asthma visits is effective, even without a financial incentive.

Effect of PM2.5 Levels on Respiratory Pediatric ED Visits in a Semi-Urban Greek Peninsula.

Ambient air pollution accounts for an estimated 4.2 million deaths worldwide. Particulate matter (PM)2.5 particles are believed to be the most harmful, as when inhaled they can penetrate deep into the lungs. The aim of this study was to examine the relationship between PM2.5 daily air concentrations and pediatric emergency department (ED) visits for respiratory diseases in a Greek suburban area. All pediatric ED visits for asthma-, pneumonia- and upper respiratory infection (URI)-related complaints were recorded during the one-year period. The 24-h PM2.5 air pollution data were prospectively collected from twelve fully automated air quality monitoring stations. The mean annual concentration of PM2.5 was 30.03 μg/m3 (World Health Organization (WHO) Air Quality Guidelines (AQG) Annual mean concentration: 10 μg/m3). PM2.5 levels rose above the WHO Air Quality Guidelines (AQG) 24-h concentrations (25 μg/m3)), 178 times (48.6% of the study period). When PM2.5 levels were above the daily limit, an increase of 32.44% (p < 0.001) was observed in daily pediatric ED visits for respiratory diseases and the increase was much higher during spring (21.19%, p = 0.018). A 32% (p < 0.001) increase was observed in URI-related visits, when PM2.5 levels were ≥25 μg/m3, compared to the mean daily visits when PM2.5 levels were <25 μg/m3. Air pollution levels were associated with increased pediatric ED visits for respiratory-related diseases.

The association between asthma emergency department visits and satellite-derived PM2.5 in Lima, Peru

BackgroundAsthma affects millions of people worldwide. Lima, Peru is one of the most polluted cities in the Americas but has insufficient ground PM2.5 (particulate matter that are 2.5 μm or less in diameter) measurements to conduct epidemiologic studies regarding air pollution. PM2.5 estimates from a satellite-driven model have recently been made, enabling a study between asthma and PM2.5. ObjectiveWe conducted a daily time-series analysis to determine the association between asthma emergency department (ED) visits and estimated ambient PM2.5 levels in Lima, Peru from 2010 to 2016. MethodsWe used Poisson generalized linear models to regress aggregated counts of asthma on district-level population weighted PM2.5. Indicator variables for hospitals, districts, and day of week were included to account for spatial and temporal autocorrelation while assessing same day, previous day, day before previous and average across all 3-day exposures. We also included temperature and humidity to account for meteorology and used dichotomous percent poverty and gender variables to assess effect modification. ResultsThere were 103,974 cases of asthma ED visits during the study period across 39 districts in Lima. We found a 3.7% (95% CI: 1.7%–5.8%) increase in ED visits for every interquartile range (IQR, 6.02 μg/m3) increase in PM2.5 same day exposure with no age stratification. For the 0–18 years age group, we found a 4.5% (95% CI: 2.2%–6.8%) increase in ED visits for every IQR increase in PM2.5 same day exposure. For the 19–64 years age group, we found a 6.0% (95% CI: 1.0%–11.0%) increase in ED visits for every IQR in average 3-day exposure. For the 65 years and up age group, we found a 16.0% (95% CI: 7.0%–24.0%) decrease in ED visits for every IQR increase in PM2.5 average 3-day exposure, although the number of visits in this age group was low (4,488). We found no effect modification by SES or gender. DiscussionResults from this study provide additional literature on use of satellite-driven exposure estimates in time-series analyses and evidence for the association between PM2.5 and asthma in a low- and middle-income (LMIC) country.

Asthma education and specialized care after pediatric emergency department visits: Real-life impact

BACKGROUND: Although asthma education and medical follow-up improve asthma control in efficacy trials, implementation issues may affect real-life effectiveness. OBJECTIVES: To assess the real-life impact of asthma education and/or specialized asthma care (SAC), in children referred to the Asthma Education Center (AEC) following an emergency department (ED) visit for asthma. METHODS: We conducted a retrospective cohort study of children aged 0-17 years, presenting to the ED between 2001 and 2006 for asthma, and referred to the AEC. Patients were considered exposed to AEC or SAC from their first visit, exposed to both AEC and SAC when both services had been received and unexposed otherwise. A Cox proportional hazards model was used to estimate the association of AEC and/or SAC with time-to-subsequent asthma ED visit in the 12 months following the index visit. RESULTS: Of the 1,233 children (mean age: 4.4 years; 63.5% male), 46% received both AEC and SAC; 19%, AEC alone, and 8%, SAC alone; 56% AEC with SAC occurring <1 month of the index ED visit. Compared to unexposed, the likelihood (HR [95% CI]) of a subsequent ED visit was significantly lower in children receiving AEC with SAC (0.43 [0.34, 0.53]) and AEC alone (HR = 0.68 [0.53, 0.86]), but not in those receiving SAC alone (HR = 0.85 [0.64, 1.14]). CONCLUSION: Following an AEC referral after an ED visit, children who received AEC alone or with SAC, had a lower likelihood of a subsequent ED visit; no significant reduction was noted with SAC alone, underlying the real-life effectiveness and importance of asthma education.

Determinants of asthma-related emergency department return visits in adults: A population-based study

RATIONALE: Emergency department (ED) return-visit rates provide a measure of the quality of acute asthma care. OBJECTIVES: We sought to assess the impact of patient and site characteristics, including asthma management strategies, on return visits within 72 hours, prior to implementation of a standardized adult ED asthma care pathway in EDs throughout Ontario, Canada. METHODS: This population-based cohort study utilized comprehensive administrative health data from the Institute for Clinical Evaluative Sciences for adults 20 to 64 years old who had at least one ED visit for asthma from April 1, 2006 to March 31, 2008. Detailed information on ED management strategies was available on a subset of 37 sites whose staff attended pathway implementation workshops. MEASUREMENTS AND MAIN RESULTS: A total of 41,140 asthma visits to 167 EDs were analyzed. Most patients (64.8%) were triaged as high acuity and the majority (92.8%) were discharged. The return-visit rate was 2.8%. Female gender, younger age, higher acuity, leaving the ED before visit completion and prior admission or ED visit for asthma were associated with increased odds of a return visit. The only management strategy associated with reduced ED visits was access to 24-hour peak flow measurement. CONCLUSION: This study identified well-recognized patient- and hospital-level risk factors for return ED visits. Access to peak flow monitoring was the only protective management strategy found. As many ED asthma service and care gaps exist, province-wide implementation of a standardized care pathway may greatly impact ED management and improve patient outcomes including return ED visits.

Hot spots for pediatric asthma emergency department visits in Ottawa, Canada

Objective Pediatric asthma emergency department (ED) visits and repeat visits place a substantial burden on healthcare. National and provincial level studies demonstrate geographic variation in asthma ED visits and links to marginalization, but preclude translation into practical targeting of healthcare delivery. It is important to understand the relationship between pediatric asthma ED visits and marginalization at a more granular level. To map the city-level geographic variation in pediatric asthma ED visit and re-visit rates at the Children’s Hospital of Eastern Ontario (CHEO) in Ottawa, Canada and the relationship with marginalization. Methods We performed a single center retrospective cohort study of children ages 1–17 with one or more ED visits for asthma at the CHEO in Ottawa. Using postal codes, we linked patients to census tracts. Per census tract, we mapped pediatric asthma ED visit and re-visit rates within one year and identified overlap with the Ontario Marginalization Index. Results Of 1,620 children with an index ED visit, 18.5% had a repeat ED visit. We identified 10 hot spot census tracts each for pediatric asthma ED visit and re-visit rates. We identified an overlap between urban hot spots and areas with high ethnic concentration or low dependency. Conclusion At a granular, city-wide level, pediatric asthma ED visit and re-visit rates are heterogeneous. Urban hot spots, in contrast to rural, have more overlap with marginalization, especially ethnic concentration. These methods can be used in other jurisdictions to inform practical community strategies for geographically-targeted prevention of pediatric asthma-related ED visits in vulnerable areas. Abbreviations: ED: Emergency department; CHEO: Children’s Hospital of Eastern Ontario; PRAM: Pediatric Respiratory Assessment Measure; ON-Marg: Ontario Marginalization Index; SES: Socioeconomic status; US: United States Supplemental data for this article can be accessed at publisher’s website.

Climate change, aeroallergens, and the aeroexposome

Allergic diseases are a major public health problem globally and are increasing. The impacts of climate change on aeroallergens such as pollen and fungal spores and allergic respiratory diseases such as allergic asthma and allergic rhinitis have been considered since the early years of climate change and human health research, and exploration of this topic has accelerated over the past decade or so. This review examines the impacts of climate change on aeroallergens, including interactions with air pollutants, and the resulting impacts on allergic respiratory diseases. It discusses mitigation and adaptation in this context. It does this with a focus on advances over the last 2 years (2019 and 2020) to highlight research at the frontier of this field. It also explores the growing recognition of the need for a more holistic and integrated approach to environmental monitoring and exposure and presents the concept of the aeroexposome as a frame through which these impacts of climate change and responses to them could be viewed moving forward. As the evidence of impacts of climate change on aeroallergen production and atmospheric concentration, seasonality, distribution, and allergenicity mounts, crucial research demonstrating the resulting impacts on health outcomes such as aeroallergen sensitisation prevalence, asthma emergency department visits, and asthma hospitalisations is now emerging. It is vital that the momentum of the last decade continue with research to fill the many gaps that remain in our knowledge of this complex topic—refining analytical techniques, broadening the geographical coverage (to include, for example, the Southern Hemisphere), and more explicitly exploring the impacts of climate change on indoor aeroallergens.

Pediatric asthma exacerbations during the COVID-19 pandemic: Absence of the typical fall seasonal spike in Washington, DC

Pediatric asthma exacerbations during the COVID-19 pandemic: Absence of the typical fall seasonal spike in Washington, DC

Sulfur dioxide and exacerbation of allergic respiratory diseases: A time-stratified case-crossover study.

Background:Strong epidemiological evidence suggests that air pollution plays a significant role in the exacerbation of allergic respiratory diseases. This study aimed to assess the potential relationship between daily levels of sulfur dioxide (SO2) and emergency department (ED) visits for allergic diseases.Materials and Methods:Data regarding ED visits for allergic respiratory diseases were routinely collected from the EDs in the Zlatibor district, and the General Hospital, Užice. The daily average concentrations of SO2 were obtained from the regional automatic air quality monitoring stations. All data were collected from June 2012 to July 2014. A time-stratified case-crossover design was used. Crude odds ratios (ORs) and ORs adjusted for weather conditions were calculated using conditional logistic regression.Results:Statistically significant associations were seen between 0-day lagged exposure to SO2 and ED visits for all allergic diseases (OR = 1.62; 95% confidence interval [CI]: 1.05–2.48; P = 0.028) and between 2-day lagged exposure to SO2 and ED visits for asthma with allergic rhinitis (OR = 2.00; 95% CI: 1.03–3.88; P = 0.042). These results were adjusted for temperature, temperature2, and humidity.Conclusion:Our results suggest that short-term exposure to SO2 conferred an increased risk of ED visits for allergic respiratory diseases, particularly for asthma with concomitant allergic rhinitis.

Potential health benefits of sustained air quality improvements in New York City: A simulation based on air pollution levels during the COVID-19 shutdown

New York City (NYC) experienced a sharp decline in air pollution during the COVID-19 shutdown period (March 15, 2020 to May 15, 2020)—albeit at high social and economic costs. It provided a unique opportunity to simulate a scenario in which the city-wide air quality improvement during the shutdown were sustained over the five-year period, 2021 through 2025, allowing us to estimate the potential public health benefits to children and adults and their associated economic benefits.We focused on fine particulate matter (PM2.5) and modeled potential future health benefits to children and adults. The analysis considered outcomes in children that have not generally been accounted for in clean air benefits assessments, including preterm birth, term low birthweight, infant mortality, child asthma incidence, child asthma hospital admissions and emergency department visits, autism spectrum disorder, as well as adult mortality.We estimated a city-wide 23% improvement in PM2.5 levels during the COVID-19 shutdown months compared to the average level for those months in 2015–2018 (the business as usual period). Based on the data for 2020, we extrapolated the ambient levels of PM2.5 for the following five-year period. The estimated cumulative benefits for 2021–2025 included thousands of avoided cases of illness and death, with associated economic benefits from $31.8 billion to $77 billion.This “natural experiment,” tragic though the cause, has provided a hypothetical clean air scenario that can be considered aspirational—one that could be achieved through transportation, climate, and environmental policies that support robust economic recovery with similarly reduced emissions.

Unraveling racial disparities in asthma emergency department visits using electronic healthcare records and machine learning

Objective Hospital emergency department (ED) visits by asthmatics differ based on race and season. The objectives of this study were to investigate season- and race-specific disparities for asthma risk, and to identify environmental exposure variables associated with ED visits among more than 42,000 individuals of African American (AA) and European American (EA) descent identified through electronic health records (EHRs). Methods We examined data from 42,375 individuals (AAs = 14,491, EAs = 27,884) identified in EHRs. We considered associated demographic (race, age, gender, insurance), clinical (smoking status, ED visits, FEV1%), and environmental exposures data (mold, pollen, and pollutants). Machine learning techniques, including random forest (RF), extreme gradient boosting (XGB), and decision tree (DT) were used to build and identify race- and -season-specific predictive models for asthma ED visits. Results Significant differences in ED visits and FEV1% among AAs and EAs were identified. ED visits by AAs was 32.0% higher than EAs and AAs had 6.4% lower FEV1% value than EAs. XGB model was used to accurately classify asthma patients visiting ED into AAs and EAs. Pollen factor and pollution (PM2.5, PM10) were the key variables for asthma in AAs and EAs, respectively. Age and cigarette smoking increase asthma risk independent of seasons. Conclusions In this study, we observed racial and season-specific disparities between AAs and EAs asthmatics for ED visit and FEV1% severity, suggesting the need to address asthma disparities through key predictors including socio-economic status, particulate matter, and mold.