Asthma Hospitalization Research Articles

123 Reduction of asthma hospitalizations in children in a tertiary care center in Quebec during the early confinement period of the COVID-19 pandemic

Primary Subject areaRespirologyBackgroundAsthma in children and adolescents is a major cause of urgent visits and hospitalizations. In preschoolers, viral infections remain the main cause of these exacerbations, although environmental factors may also play a role. In older children and adolescents, many other risk factors are present including respiratory allergies, exercise, strong emotions, active and passive smoking and poor adherence to recommended treatments. In the context of the COVID-19 pandemic, clinicians have been concerned about the possibility of a significant increase in urgent consultations for asthma in children. However, due to the confinement imposed on a large part of the population from March 2020, we have suspected a reduction in the number of viral infections leading to urgent visits and hospitalizations in pediatric patients.ObjectivesOur hypothesis was that the number of children hospitalized with asthma exacerbations during the pandemic lockdown declined significantly. Our objective was to determine if the number and severity of hospitalizations at the CME of the CHU de Québec for asthma exacerbations in children aged 1 to 17 had significantly decreased during the confinement period from April 1 to July 1, 2020 and to what extent, according to various clinical features.Design/MethodsRetrospective study reviewing episodes of care in medical records in children aged 1 to 17 and hospitalized on all wards at the CME-CHU de Québec. All patients with primary diagnosis of asthmatic exacerbation according to the summary sheets between April 1 to July 1, 2020 for the study group and from April 1 to July 1, 2019 for the control group were included. We aimed to determine the number of hospitalizations for this diagnosis for each period and determine the length of stay on the various pediatric wards for each episode of care according to the established criteria. We have determined the presence of risk factors (asthma diagnosis, underlying condition, regular asthma medication, allergies, and other factors relevant to asthma).We have further determined the presence of gravity markers during the course of hospitalization (need for: IV corticosteroids, Mg sulfate, IV bronchodilators, non-invasive ventilation, intubation, ICU stay and radiological pneumonia) for each episode of care. The data was denominated and collated in an encoded file, and shareable only between the investigators.ResultsAfter exclusions, a total of 97 charts were analyzed. Between April 1 and July 1 2019, a total of 89 patients were admitted with a diagnosis of asthma exacerbation while only eight patients were admitted during the same period in 2020. The median age of patients admitted in 2020 was higher than in 2019 (53 vs 25 months). In 2019, 40 children (48%) had a previous diagnosis of asthma, of whom 28 used regular controller medications compared to 2 children (25%) in 2020, both taking regular controller medications. More patients had an associated diagnosis of upper respiratory tract infection in 2019 than in 2020 (92% vs 63%). Nine patients required intensive care in 2019 compared to none in 2020.ConclusionCompared to 2019, hospital admissions for asthma exacerbations in our tertiary care centre in Quebec City were significantly lower during the early phase of the 2020 pandemic. More research is required to determine the exact causes of this significant reduction.

The short-term association between air pollution and asthma hospitalization: a time-series analysis

The short-term association between air pollution and asthma hospitalization: a time-series analysis

Air pollution and pediatric respiratory hospital admissions in Bursa, Turkey: A time series study

ABSTRACT We aimed to investigate the relation between air pollution and the number of daily hospitalizations due to pneumonia, asthma, bronchitis in children aged 0–18 in Bursa city of Turkey, between the years 2013–2018. The daily values of air pollutants (PM10, SO2, NO2, NOx, CO, and O3) from 2013 until 2018, were obtained. Adjusted Quasi-Poisson regression models including distributed lags, controlled for climate variables were used for data analysis. Increases in SO2, ozone, PMs, and nitrogen oxides were associated with pneumonia hospitalizations, increases in SO2 NOx and PMs were associated with asthma hospitalizations, and increases in SO2 and ozone were associated with bronchitis hospitalizations. Male hospitalization was related with SO2, ozone, and NOx; while female hospitalization was only related with SO2. This study showed that short-term exposure to air pollution is associated with an increased risk of pneumonia, asthma, and bronchitis hospitalization among children in Bursa.

Understanding caregiver perspectives on challenges and solutions to pediatric asthma care for children with a previous hospital admission: a multi-site qualitative study

Objective Pediatric hospital admissions for asthma provide an opportunity to trigger a review of the current management with an aim of preventing readmissions. However, caregiver voices on how best to improve care are missing. Methods As part of a larger, mixed methods cohort study, we identified caregivers of children aged 3–18 years who had an index hospital admission to a tertiary pediatric, mixed adult and pediatric, or regional hospital in Victoria, Australia, between 1st September 2017 and 31st August 2018 with a discharge diagnosis of “Asthma” or “Wheeze” based on International Classification of Disease-10 coding. We conducted qualitative semi-structured interviews with a purposive sample of 39 caregivers. We used content analysis to identify themes from the data. Results Caregivers identified both challenges associated with asthma care for children with a previous hospital admission as well as solutions to improve care and potentially reduce readmissions. Key challenges included: unclear pathways for follow up care, inconsistent advice, lack of personalized management, delays in getting a diagnosis, delays in the prescription of a preventer medication, and difficulty accessing primary care during exacerbations. Follow up with an “asthma specialist”, early access to a trial of preventer medication, personalized Written Asthma Action Plans and increased access to and quality of community-based asthma support services were identified as key solutions. Conclusions Caregivers have identified several potential solutions that could be implemented to improve care and possibly reduce pediatric asthma hospital readmissions. The challenge now is to co-design, embed and evaluate these in healthcare systems. Supplemental data for this article can be accessed at publisher’s website.

SOCIOECONOMIC STATUS AFFECTS ASTHMA MORBIDITY MEASURES AMONG BLACK AND LATINX PATIENTS

SOCIOECONOMIC STATUS AFFECTS ASTHMA MORBIDITY MEASURES AMONG BLACK AND LATINX PATIENTS

Impact of COVID-19 on hospitalisations for asthma

Impact of COVID-19 on hospitalisations for asthma

Seasonal characteristics of temperature variability impacts on childhood asthma hospitalization in Hefei, China: Does PM2.5 modify the association?

ObjectivesEvidence of childhood asthma hospitalizations associated with temperature variability (TV) and the attributable risk are limited in China. We aim to use a comprehensive index that reflected both intra- and inter-day TV to assess the TV-childhood asthma relationship and disease burden, further to identify seasonality vulnerable populations, and to explore the effect modification of PM2.5. MethodsA quasi-distributed lagged nonlinear model (DLNM) combined with a linear threshold function was applied to estimate the association between TV and childhood asthma hospitalizations during 2013–2016 in Hefei, China. Subgroup analysis was conducted by age and sex. Disease burden is reflected by the attributable fraction and attributable number. Besides, modifications of PM2.5 were tested by introducing the cross-basis of TV and binary PM2.5 as an interaction term. ResultsThe risk estimates peaked at TV0-3 and TV0-4 in the cool and the warm season separately, with RR of 1.051 (95%CI: 1.021–1.081) and 1.072 (95%CI: 1.008–1.125), and the effects lasted longer in the cool season. The school-age children in the warm season and all subgroups except pre-school children in the cool season were vulnerable to TV. It is estimated that the disease burden related to TV account for 6.2% (95% CI: 2.7%–9.4%) and 4% (95% CI: 0.6%–7.1%) during the cool and warm seasons in TV0-3. In addition, the risks of TV were higher under the high PM2.5 level compared with the low PM2.5 level in the cool season, although no significant differences between them. ConclusionsTV exposure significantly increases the risk and disease burden of childhood asthma hospitalizations, especially in the cool season. More medical resources should be allocated to school-age children. Giving priority to pay attention to TV in the cool season in practice could obtain the greatest public health benefits and those days with high TV and high PM2.5 need more attention.

Time trends of chronic immune diseases by year of birth in Danish registries.

Chronic immune diseases are often reported to be on the rise and are speculated to share early life risk factors. Here, we investigated year of birth as a common denominator for time trends using the consistent data source of the Danish National Patient Registry with 35years nationwide coverage. Observational nationwide birth cohort registry study, where persons born in Denmark since 1953 were investigated for chronic immune diseases per person years at risk. Outcomes were defined by inpatient hospitalizations in pre-chosen age bins by year of birth in 5year bins. A population of 3.8 million persons born in Denmark since 1953 was investigated for a total sum of 68 million person years in the ages 5-34years. We found increasing trends by year of birth for juvenile arthritis age 10-14, adult asthma age 20-24, inflammatory bowel diseases age 20-24, and multiple sclerosis age 25-29, whereas type 1 diabetes age 15-19 was declining until birth year mid 1980s followed by a subsequent increase. Childhood asthma age 5-9 inpatient hospitalizations were relatively stable over time. Nationwide introduction of measles, mumps, rubella vaccine in 1987 did not alter the trends. Hospitalization for the chronic immune diseases adult asthma, juvenile arthritis, inflammatory bowel diseases and multiple sclerosis showed a general increasing trend by birth year in recent 35years while diabetes 1 and childhood asthma seemed stable in this period. These results were not affected by the introduction of vaccinations against the major childhood viral infections.

Adenotonsillectomy, bronchoscopy and bronchoalveolar lavage in the management of preschool children with severe asthma: pilot study.

This is a pilot study thatdescribes the feasibility and clinical course of a cohort of preschool children with severe asthma undergoing a combined adenotonillectomy (TA), bronchoscopy (B), and bronchoalveolar lavage (BAL) procedure. A retrospective cohort study of preschool patients with severe asthma who underwent a combined TA-B-BAL procedure between 2012 and 2019. Subjects were treated at a tertiary care asthma clinic and had a diagnosis of preschool asthma according to the Canadian Thoracic Society Guidelines. Data on demographics, clinical characteristics, medication use, virology and microbiology from bronchoalveolar lavage, and asthma control questionnaires were collected. Variables were analyzed using paired t test. Eighteen preschool subjects (mean age 3.19 ± 1.13years) with severe asthma were identified through the asthma clinic. Patients treated with standard asthma care and a combined TA-B-BAL procedure experienced a decrease in the number of oral steroid courses (p = 0.017), emergency department visits (p = 0.03) and wheezing exacerbations (p = 0.026) following the procedure. Ten patients experienced clinically meaningful improvements in TRACK scores after the procedure (p < 0.001). This pilot study provides early evidence that a combined TA-B-BAL procedure is feasible in preschool children with severe asthma and that the procedure may reduce asthma medication use and hospital visits.

Asthma Surveillance - United States, 2006-2018.

ProblemAsthma is a chronic disease of the airways that requires ongoing medical management. Socioeconomic and demographic factors as well as health care use might influence health patterns in urban and rural areas. Persons living in rural areas tend to have less access to health care and health resources and worse health outcomes. Characterizing asthma indicators (i.e., prevalence of current asthma, asthma attacks, emergency department and urgent care center [ED/UCC] visits, and asthma-associated deaths) and determining how asthma exacerbations and health care use vary across the United States by geographic area, including differences between urban and rural areas, and by sociodemographic factors can help identify subpopulations at risk for asthma-related complications.Reporting Period2006–2018.Description of SystemThe National Health Interview Survey (NHIS) is an annual cross-sectional household health survey among the civilian noninstitutionalized population in the United States. NHIS data were used to produce estimates for current asthma and among them, asthma attacks and ED/UCC visits. National Vital Statistics System (NVSS) data were used to estimate asthma deaths. Estimates of current asthma, asthma attacks, ED/UCC visits, and asthma mortality rates are described by demographic characteristics, poverty level (except for deaths), and geographic area for 2016–2018. Trends in asthma indicators by metropolitan statistical area (MSA) category for 2006–2018 were determined. Current asthma and asthma attack prevalence are provided by MSA category and state for 2016–2018. Detailed urban-rural classifications (six levels) were determined by merging 2013 National Center for Health Statistics (NCHS) urban-rural classification data with 2016–2018 NHIS data by county and state variables. All subregional estimates were accessed through the NCHS Research Data Center.ResultsCurrent asthma was higher among boys aged <18 years, women aged ≥18 years, non-Hispanic Black (Black) persons, non-Hispanic multiple-race (multiple-race) persons, and Puerto Rican persons. Asthma attacks were more prevalent among children, females, and multiple-race persons. ED/UCC visits were more prevalent among children, women aged ≥18 years, and all racial and ethnic groups (i.e., Black, non-Hispanic Asian, multiple race, and Hispanic, including Puerto Rican, Mexican, and other Hispanic) except American Indian and Alaska Native persons compared with non-Hispanic White (White) persons. Asthma deaths were higher among adults, females, and Black persons. All pertinent asthma outcomes were also more prevalent among persons with low family incomes. Current asthma prevalence was higher in the Northeast than in the South and the West, particularly in small MSA areas. The prevalence was also higher in small and medium metropolitan areas than in large central metropolitan areas. The prevalence of asthma attacks differed by MSA category in four states. The prevalence of ED/UCC visits was higher in the South than the Northeast and the Midwest and was also higher in large central metropolitan areas than in micropolitan and noncore areas. The asthma mortality rate was highest in non-MSAs, specifically noncore areas. The asthma mortality rate was also higher in the Northeast, Midwest, and West than in the South. Within large MSAs, asthma deaths were higher in the Northeast and Midwest than the South and West.InterpretationDespite some improvements in asthma outcomes over time, the findings from this report indicate that disparities in asthma indicators persist by demographic characteristics, poverty level, and geographic location.Public Health ActionDisparities in asthma outcomes and health care use in rural and urban populations identified from NHIS and NVSS can aid public health programs in directing resources and interventions to improve asthma outcomes. These data also can be used to develop strategic goals and achieve CDC’s Controlling Childhood Asthma and Reducing Emergencies (CCARE) initiative to reduce childhood asthma hospitalizations and ED visits and prevent 500,000 asthma-related hospitalizations and ED visits by 2024.

Pollution at schools and children's aerobic capacity.

Poor respiratory health is a major cause of mortality and morbidity worldwide, and children are especially vulnerable. Existing research in economics has documented the effect of pollution on severe health outcomes, such as hospitalizations for asthma and infant death. However, evidence on the effect of air pollution on less extreme measures of respiratory health is limited, because these effects are difficult to measure. Using a more sensitive measure, aerobic capacity ( ), I study the impact of air pollution on respiratory performance of children. I combine school-grade level data from the California Physical Fitness Test from 2009 to 2017 with local air pollution and weather data to estimate the impact on student aerobic capacity of fluctuations in air pollution levels on testing days. Ozone affects child aerobic capacity at levels even below the Environmental Protection Agency thresholds.

Ambient PM2.5 and PM10 Exposure and Respiratory Disease Hospitalization in Kandy, Sri Lanka.

Evidence of associations between exposure to ambient air pollution and health outcomes are sparse in the South Asian region due to limited air pollution exposure and quality health data. This study investigated the potential impacts of ambient particulate matter (PM) on respiratory disease hospitalization in Kandy, Sri Lanka for the year 2019. The Generalized Additive Model (GAM) was applied to estimate the short-term effect of ambient PM on respiratory disease hospitalization. As the second analysis, respiratory disease hospitalizations during two distinct air pollution periods were analyzed. Each 10 μg/m3 increase in same-day exposure to PM2.5 and PM10 was associated with an increased risk of respiratory disease hospitalization by 1.95% (0.25, 3.67) and 1.63% (0.16, 3.12), respectively. The effect of PM2.5 or PM10 on asthma hospitalizations were 4.67% (1.23, 8.23) and 4.04% (1.06, 7.11), respectively (p < 0.05). The 65+ years age group had a higher risk associated with PM2.5 and PM10 exposure and hospital admissions for all respiratory diseases on the same day (2.74% and 2.28%, respectively). Compared to the lower ambient air pollution period, higher increased hospital admissions were observed among those aged above 65 years, males, and COPD and pneumonia hospital admissions during the high ambient air pollution period. Active efforts are crucial to improve ambient air quality in this region to reduce the health effects.

Pediatric Asthma Exacerbation in Children with Suspected and Confirmed Coronavirus Disease 2019 (COVID-19): An Observational Study from Saudi Arabia.

BackgroundMost asthma exacerbations are caused by viral respiratory infections such as rhinovirus, coronaviruses, influenza viruses, and many others. While there have been data about the impact of COVID-19 on adult asthma, much remains unknown about the impact of COVID-19 on childhood asthma.MethodsThis retrospective cohort study included all pediatric patients aged 2 to 12 years who were admitted to Abha Maternity and Children Hospital for acute asthma exacerbation between June 1, 2020, and May 31, 2021, and underwent testing for SARS-CoV-2 using nasopharyngeal real-time polymerase chain reaction.ResultsSixty children hospitalized with the diagnosis of asthma were included in the study. Out of these patients, 10 (16.7%) were diagnosed with COVID-19. The enrolled patients were between 2 and 12 years, with a median age of five years (interquartile range, 3.8), and 58% were males (35/60). Cough, shortness of breath, and hypoxia were the most common presenting symptoms and signs. Severe asthma was more prevalent among positive COVID-19 compared with negative COVID-19 patients (60 vs 20%; P= 0.016). In addition, chronic asthma for more than five years was more prevalent among positive COVID-19 than negative COVID-19 patients (60 vs 40%, P= 0.305). Fifty-five percent of the enrolled patients had eosinophilic asthma using a 300cells/μL threshold. None of the children required invasive respiratory support (ventilation through an endotracheal tube or tracheostomy), but 12 patients (21.7%) required respiratory support via high-flow nasal cannula. The total days of hospitalization in either PICU or pediatric general ward did not differ between the two groups. All patients were discharged, and there were no reports of serious morbidity or mortality.ConclusionEosinophilic asthma was the most prevalent asthma phenotype in the study group. Furthermore, there was no difference in the presenting symptoms of an asthma flare-up, laboratory indicators, and hospitalization outcomes (critical care admission and hospital stay) between asthmatics with and without a COVID-19 diagnosis.

Managing Exacerbations in Thunderstorm Asthma: Current Insights.

Epidemic thunderstorm asthma (ETSA) occurs following a thunderstorm due to the interaction of environmental and immunologic factors. Whilst first reported in the 1980s, the world’s largest event in Melbourne, Australia, on November 21, 2016 has led to a wealth of clinical literature seeking to identify its mechanisms, susceptibility risk factors, and management approaches. Thunderstorm asthma (TA) typically presents during an aeroallergen season in individuals sensitized to perennial rye grass pollen (RGP) in Australia, or fungus in the United Kingdom, in combination with meteorological factors such as thunderstorms and lightning activity. It is now well recognized that large pollen grains, which usually lodge in the upper airway causing seasonal allergic rhinitis (SAR), are ruptured during these events, leading to sub-pollen particles respirable to the lower respiratory tract causing acute asthma. The identified risk factors of aeroallergen sensitization, specifically to RGP in Australians with a history of SAR, and individuals born in Australia of South-East Asian descent as a risk factor for TA has been key in selecting appropriate patients for preventative management. Moreover, severity-determining risk factors for ETSA-related asthma admission or mortality, including pre-existing asthma or prior hospitalization, poor inhaled corticosteroid adherence, and outdoor location at the time of the storm are important in identifying those who may require more aggressive treatment approaches. Basic treatments include optimizing asthma control and adherence to inhaled corticosteroid therapy, treatment of SAR, and education regarding TA to increase recognition of at-risk days. Precision treatment approaches may be more beneficial in select individuals, including the use of allergen immunotherapy and even biologic treatment to mitigate asthma severity. Finally, we discuss the importance of environmental health literacy in the context of concerns surrounding the increased frequency of ETSA due to climate change and its implications for the frequency and severity of future events.

Increased hospital admissions for asthma from short-term exposure to cold spells in Beijing, China.

There is a paucity of studies investigating extreme cold events and asthma exacerbations. This study examined whether an association exists between cold spells and daily hospital admissions for asthma in Beijing, China from 2012 to 2016. Daily hospital admissions for asthma, meteorological variables and air quality data were collected during 2012-2016 in Beijing. A cold spell was defined as a period of at least two consecutive days with the daily mean temperature below or at the 5th percentile (-7°C) in cold seasons (November to March) during the study period. We applied a time-series design using quasi-Poisson regression combined with a distributed lag model to estimate the risk of asthma hospital admissions associated with cold spells. Stratified analyses by gender and age groups were conducted to identify the potential susceptible subpopulations to cold spells. We also explored the effect modification by air quality by dividing the daily air quality index (AQI) into two levels (high and low) based on the median value. Cold spells increased the risk of asthma hospital admissions, with the maximum cumulative relative risk (CRR) over three weeks (Lag0-21) in the total population. The highest single-day relative risk (RR) was found on the days of cold spells (Lag0) with the RR=1.059 (95% CI: 1.008-1.113), and the CRR at Lag0-21 was 1.333 (95% CI: 1.049-1.693). Across different gender and age groups, younger people (<65 years) were more sensitive to cold spells. No significant effect modification by AQI was detected. Short-term exposure to cold spells is associated with an increased risk of hospital admissions for asthma in Beijing. During the cold spells, younger people aged <65 years were at particular risk for asthma exacerbations. Our results suggest that extreme cold events have a significant impact on asthma.

Impact of COVID-19 on (Non-COVID) chronic respiratory disease outcome survey in India (CCROS study).

Background:India has high prevalence of chronic respiratory diseases, especially bronchial asthma and chronic obstructive pulmonary disease (COPD). Both of these are also recognized as risk factors for severity and poor outcome of COVID-19 disease. It is assumed that COVID-19 outbreak as well as an effective lockdown might have affected the incidence and outcome of some of these.Methods:To substantiate above hypothesis, an online survey was mailed to 547 pulmonologists across the country; 314 (54.7%) responses were recorded in the given period. The survey included observations on incidence and outcome of common chronic respiratory diseases such as asthma, COPD and interstitial lung diseases (ILD) in predefined pre-COVID and during COVID period in a total of 24 questions.Results:It was observed that the reduction in incidence of outpatient department cases, acute exacerbations and hospitalization for asthma, COPD and ILD was statistically significant. The outcome of acute exacerbations of these chronic respiratory diseases was analyzed in terms of discharges from hospitals after satisfactory recovery and/ or mortalities. For COPD and ILD, it was not significantly affected during the COVID period. At the same time, a relatively higher proportion of acute asthma mortality was reported. A wide variation in nebulization practices was reported during this period. The doses of inhaled corticosteroids in asthma management were not affected. A wide variety of factors including effective lockdown, better quality of air and regular use of masks were probably responsible for reduced incidence of exacerbations of these chronic respiratory diseases.Conclusion:We conclude that while outpatient department visits, acute exacerbations and hospitalizations were significantly reduced during COVID-19 period, outcome of asthmatics was relatively unfavorable as compared to that of COPD and ILDs.

Changes in Timing of Spring Onset, Pollen Exposure, and Burden of Allergic Disease in the Northeastern United States

BACKGROUND AND AIM: Ongoing climate variability and change is altering the timing of spring onset, a critical event that signifies the start of tree pollen season in North America. There is a paucity of data regarding how such changes in the timing of spring onset impact burden of allergic disease in the Northeast United States. METHODS: We processed Landsat and MODIS observations for New York and Maryland during 2001-2015 to derive the start of spring (SOS) using double logistic model and aggregated them to county level. We then calculated yearly deviations in SOS for each county for MD and NY from their respective long term median values (2001-2015). These deviations were categorized as very early, early, normal, late and very late. We linked these yearly deviations in SOS with asthma hospitalization for MD and NY during 2001-2015, based on the county of residence. We used general additive (quasi Poisson) and mixed-effect (negative binomial) models to investigate the association between changes in the timing of spring onset and asthma hospitalization. RESULTS:Very early onset of spring was associated with a 17% increase in asthma hospitalization in Maryland during spring season (incident rate ratio [IRR], 1.17; 95% CI, 1.07-1.28). Likewise late onset of spring was associated with a 7% increase in asthma hospitalization (IRR, 1.07; 95% CI, 1.00-1.15). Adjustments for extreme heat event and particulate matter with aerodynamic diameter less than 2.5 microns (PM2.5) did not change result for very early onset of spring, but late onset was no longer statistically significant. Similar analysis for NY is ongoing and will be covered in the presentation. CONCLUSIONS:Our findings suggest that early onset of spring that are tied to warming climate may increase burden of allergic disease such as asthma. KEYWORDS: Climate Change, phenology, asthma, pollen, allergy

Proxy exposure indicators for indoor air pollution, health impact and deprivation in the Marche region, Italy

BACKGROUND AND AIM: In 2016 indoor pollution caused 3.8 million deaths attributable to respiratory, cardiovascular diseases and cancers. The aim of this study is to evaluate in our Marche region, possible association between hospitalization for asthma, Extrinsic Allergic Alveolitis (EAA) and Carbon Monoxide Intoxication (COI) and two proxy indicators of the exposure to indoor air pollution, such as PM2.5 concentration and socioeconomic deprivation index (DI). METHODS: We included subject’s hospital admissions residing in the Marche region between 2006 and 2013. For PM2.5 air concentrations we used estimates provided by the atmospheric modelling system of Italian National Integrated Assessment Model (AMS-MINNI). Exposure was defined on the basis of the quintiles of PM2.5 municipalities distribution values. Socio-economic disadvantage was measured through the DI built considering five features of the resident population: low instruction, unemployment/first job-employment, rent living, being part of a single parent family and high population density. The DI provides following municipalities classification: very wealthy, wealthy, middle, deprived, very deprived. RESULTS:Regarding asthma, results show a higher risk of hospitalization with the increasing of PM2.5 concentration quintiles. The risk increases by 35% (90% CI 1.09-1.65) for the third and fourth quintile compared to the first and 30% (90% CI 1.07-1.59) for the highest quintile. For EAA and CO intoxication there is an evident risk gradient of hospitalization as the DI increases despite the low number of events for these pathologies. CONCLUSIONS:This work confirms that PM2.5 concentration has an impact in increasing hospital admissions due to asthma and suggests a possible correlation between lower socio-economic status and increased risk of hospitalization due to EAA and CO intoxication. KEYWORDS: Air pollution, Socio-economic factors, Allergies, Respiratory outcomes, Asthma

The Association of Environmental Factors and COVID19 on Acute Pediatric Asthma-Related Healthcare Utilization in New York City: A Retrospective Analysis

BACKGROUND AND AIM: Asthma is a multifactorial disease with well-established environmental triggers that contribute to asthma exacerbations, often requiring acute medical attention. During the onset of the COVID-19 pandemic, healthcare utilization patterns for both preventive and acute services were altered. We aim to identify how the rates of pediatric emergency department (ED) visits and hospitalizations for asthma were impacted by the COVID-19 pandemic in a hospital setting in New York City (NYC). METHODS: A time series analysis for pediatric asthma-related ED visits and hospitalizations will be analyzed from 3/1/2015 to 2/28/21. Using this data we will develop a statistical inference system to identify healthcare utilization patterns for asthma exacerbations attributable to various environmental triggers (I.e., air pollutants, pollens, infectious agents). RESULTS:Pediatric asthma-related ED visits and hospitalizations decreased by 78% and 75%, respectively, during the first year of the pandemic (3/1/20-2/28/21). During the initial 12 weeks following NYC’s PAUSE order (March 22nd, 2020) a 92% reduction in admissions was observed, relative to the same time period the previous year. We plan to use environmental exposure data to make projections of the number of ED visits and hospitalizations that would have been expected during the 1st year of the outbreak and will then compare this projected data to the observed asthma-related encounters. This counterfactual simulation will provide us insight into the difference between expected and observed asthma-related acute healthcare utilization during the pandemic. CONCLUSIONS:It is important to develop an inference system to provide insight on how changes in behavioral patterns and environment exposures affect asthma-related health care utilization, in order to plan current and future public health interventions in a timely manner. KEYWORDS: Asthma, COVID-19, Children's environmental health, Policy research, Environmental justice

Acute exposures to air pollutants and asthma hospitalization in the Medicaid population

BACKGROUND AND AIM: Few studies have investigated roles of air pollutants on asthma among disadvantaged population. It is also unclear whether some sub-populations or communities experience disproportionate risk from air pollutants. METHODS: We estimated risk of asthma hospitalization associated with moving average exposures to particulate matter (PM2.5), ozone (O3), and nitrogen dioxide (NO2) over lag 0 to 6 days among all individuals enrolled in Medicaid, the largest health coverage to Americans with low income or disabilities, 2000–2012, using a time-stratified case-crossover design. To assess the risk at low levels, we restricted the analysis to hospitalizations with exposure below increasingly stringent thresholds, including those well below the national standards. Further, we performed subgroup analyses by individual- and community-level characteristics. RESULTS:We found positive associations between acute PM2.5, O3, and NO2 exposures and risk of asthma hospitalization: 1-µg/m3 increase in PM2.5, 1-part per billion (ppb) increase in O3, and 1-ppb increase in NO2 was associated with 0.31% (95% confidence interval [CI], 0.27%–0.36%), 0.11% (95% CI, 0.07%−0.15%), and 0.28% (95% CI, 0.25%−0.32%) increase in risk of asthma hospitalization, respectively. At low exposure levels, we found greater risk associated with PM2.5 and NO2. Further, we found consistently higher risk for the three exposures among beneficiaries with only one hospitalization during study period and communities with lower population density, higher average BMI, and longer distance to the nearest hospital. CONCLUSIONS:Our study adds to the existing body of research on acute effects of air pollutants on asthma, bridges the gaps in environmental health disparities, and is useful in informing policy. We found increased risk of asthma hospitalization associated with acute exposures to PM2.5, O3, and NO2 among Medicaid beneficiaries, even at levels well below the national standards. Subgroup analyses suggest that beneficiaries with mild to moderate symptoms and those living in disadvantaged communities experienced disproportionately higher risk from the pollutants. KEYWORDS: Mixtures, Short-term exposure, Asthma, Environmental disparities, Socio-economic factors