Association between Ambient Air Pollution and Emergency Room Visits for Pediatric Respiratory Diseases: The Impact of COVID-19 Pandemic

Seasonal variation of pediatric asthma exacerbations and its association with asthma phenotypes

BACKGROUND

The objective of this study was to examine the associations of blood inflammatory phenotypes with acute pediatric asthma exacerbations during different seasons and the COVID-19 pandemic.

METHODS

A retrospective study was conducted involving 32,160 pediatric asthma patients from January 2008 to December 2021. Asthma blood inflammatory phenotypes were categorized based on low (L) and high (H) eosinophils (E) and neutrophils (N) (LBE/HBE: ≥ 0.25 × 109/L and LBN/HBN: ≥ 5 × 109/L, respectively) and logistic regression was used to examine the odds ratio (OR) of outcome variables.

RESULTS

A 109/L increase of neutrophils and eosinophils was associated with a 1.015-fold (95% CI: 1.009-1.021) and a 1.057-fold increase in the OR (95% CI: 1.026-1.088) for asthma exacerbations of hospitalized pediatric asthma patients. An increase in HBE/LBN phenotype was associated with a respective 1.232-fold (95% CI: 1.081-1.404) and 1.248-fold (95% CI: 1.101-1.414) increase in the OR for asthma exacerbations of hospitalized pediatric asthma patients before the COVID-19 pandemic in the winter and autumn seasons. However, an increase of LBE/LBN phenotype was associated with a respective 0.873-fold (95% CI: 0.769-0.991), 0.872-fold (95% CI: 0.771-0.986), and 0.813-fold (95% CI: 0.709-0.932) decrease in the OR for asthma exacerbations in the winter, spring and summer seasons.

CONCLUSIONS

HBE/LBN phenotype had a higher risk of asthma exacerbations among hospitalized pediatric asthma patients in the winter and autumn, while LBE/LBN phenotype had a lower risk in the winter, spring, and summer.

IMPACT

Blood eosinophils and neutrophils have been indicated to have a potential influence on pediatric asthma development and severity. HBE/LBN phenotype was associated with increased asthma exacerbations among hospitalized pediatric asthma patients during winter and autumn. Eosinophil and neutrophil predominance exhibited a higher influence on pediatric asthma exacerbations.

The Influence of Fine Particulate Matter and Cold Weather on Emergency Room Interventions for Childhood Asthma

(1) Background: Children are the most vulnerable to pollution due to their decreased stature, heightened respiratory rate, and frequent outdoor engagement. PM2.5, nitrogen dioxide (NO2), ozone, and cold weather are associated with pediatric asthma. In this study, we investigated the nexus between air pollution, climate factors, and pediatric asthma emergency room visits (ERVs). (2) Method: Pediatric asthma ERV data for healthcare quality from the Taiwanese National Insurance in the Taipei area were obtained from 2015 to 2019. Air pollution and climate factor data were also collected. Poisson regression was employed to determine the relationships with relative risks (RRs). (3) Results: The incidence of pediatric asthma ERVs decreased, with a crude RR of 0.983 (95% CI: 0.98-0.986, p < 0.001). Fine particulate matter (PM2.5) had an adjusted RR of 1.102 (95% CI: 1.037-1.172, p = 0.002) and a 7.7 µg/m3 increase, and air temperature had an adjusted RR of 0.813 (95% CI: 0.745-0.887, p < 0.001) comparing between the highest and lowest quarter air temperature associated with pediatric asthma ERVs. (4) Conclusions: This inquiry underscores the positive associations of PM2.5 and cold weather with pediatric asthma ERVs. The findings could guide the government to establish policies to reduce air pollution and promote children's health.

Analyzing COVID-19 and Air Pollution Effects on Pediatric Asthma Emergency Room Visits in Taiwan

(1) Background: An asthma exacerbation that is not relieved with medication typically requires an emergency room visit (ERV). The coronavirus disease 2019 (COVID-19) pandemic began in Taiwan in January of 2020. The influence of the COVID-19 pandemic on pediatric ERVs in Taiwan was limited. Our aim was to survey pediatric asthma ERVs in the COVID-19 era; (2) Methods: Data were collected from the health quality database of the Taiwanese National Health Insurance Administration from 2019 to 2021. Air pollution and climatic factors in Taipei were used to evaluate these relationships. Changes in the rates of pediatric asthma ERVs were assessed using logistic regression analysis. Poisson regression was used to evaluate the impact of air pollution and climate change; (3) Results: The rate of pediatric asthma ERVs declined in different areas and at different hospital levels including medical centers, regional and local hospitals. Some air pollutants (particulate matter ≤ 2.5 µm, particulate matter ≤ 10 µm, nitrogen dioxide, and carbon monoxide) reduced during the COVID-19 lockdown. Ozone increased the relative risk (RR) of pediatric asthma ERVs during the COVID-19 period by 1.094 (95% CI: 1.095-1.12) per 1 ppb increase; (4) Conclusions: The rate of pediatric asthma ERVs declined during the COVID-19 pandemic and ozone has harmful effects. Based on these results, the government could reduce the number of pediatric asthma ERVs through healthcare programs, thereby promoting children's health.

Association of Air Pollution with the Number of Common Respiratory Visits in Children in a Heavily Polluted Central City, China

Children's respiratory health is vulnerable to air pollution. Based on data collected from June 2019 to June 2022 at a children's hospital in Zhengzhou, China, this study utilized Spearman correlation analysis and a generalized additive model (GAM) to examine the relationship between daily visits for common respiratory issues in children and air pollutant concentrations. Results show that the number of upper respiratory tract infection (URTI), pneumonia (PNMN), bronchitis (BCT), and bronchiolitis (BCLT) visits in children showed a positive correlation with PM2.5, PM10, NO2, SO2, and CO while exhibiting a negative correlation with temperature and relative humidity. The highest increases in PNMN visits in children were observed at lag 07 for NO2, SO2, and CO. A rise of 10 μg/m3 in NO2, 1 μg/m3 in SO2, and 0.1 mg/m3 in CO corresponded to an increase of 9.7%, 2.91%, and 5.16% in PNMN visits, respectively. The effects of air pollutants on the number of BCT and BCLT visits were more pronounced in boys compared to girls, whereas no significant differences were observed in the number of URTI and PNMN visits based on sex. Overall, air pollutants significantly affect the prevalence of respiratory diseases in children, and it is crucial to improve air quality to protect the children's respiratory health.

Association between Air Pollution and Short-Term Outcome of ST-Segment Elevation Myocardial Infarction in a Tropical City, Kaohsiung, Taiwan

ST-segment elevation myocardial infarction (STEMI), one of the primary factors leading to global mortality, has been shown through epidemiological studies to have a relationship with short-term exposure to air pollutants; however, the association between air pollutants and the outcome of STEMI has not been well studied. The aim of this study was to estimate the impact of air pollutants on the outcomes of STEMI. Data on particulate matter <2.5 μm (PM_2.5), <10 μm (PM₁₀), nitrogen dioxide (NO₂), and ozone (O₃) at each of the 11 air monitoring stations in Kaohsiung City were collected between 1 January 2012 and 31 December 2017. Medical records of non-trauma patients aged > 20 years who had presented to the Emergency Department (ED) with a principal diagnosis of STEMI were extracted. The primary outcome measure was in-hospital mortality. After adjusting for potential confounders and meteorological variables, we found that an increase in the interquartile range (IQR) in NO₂ was associated with an elevated risk of in-hospital mortality in patients with STEMI. Moreover, there was an observed higher risk of in-hospital mortality associated with an increase in the IQR of NO₂ during the warm season, specifically in lag 3 (3 days prior to the onset, OR = 3.266; 95%CI: 1.203-8.864, p = 0.02). Conversely, an IQR increase in PM₁₀ was associated with an increased risk of in-hospital mortality in patients with STEMI in lag 3 (OR = 2.792; 95%CI: 1.115-6.993, p = 0.028) during the cold season. Our study suggests that exposure to NO₂ (during the warm season) and PM₁₀ (during the cold season) may contribute to a higher risk of poor prognosis in patients with STEMI.

Machine Learning-Based Analyses of the Effects of Various Types of Air Pollutants on Hospital Visits by Asthma Patients

Asthma is a chronic respiratory disorder defined by airway inflammation, chest pains, wheezing, coughing, and difficulty breathing that affects an estimated 300 million individuals globally. Although various studies have shown an association between air pollution and asthma, few studies have used statistical and machine learning algorithms to investigate the effect of each individual air pollutant on asthma. The purpose of this research was to assess the association between air pollutants and the frequency of hospital visits by asthma patients using three analysis methods: linear correlation analyses were performed by Pearson correlation coefficients, and least absolute shrinkage and selection operator (LASSO) and random forest (RF) models were used for machine learning-based analyses to investigate the effect of air pollutants. This research studied asthma patients using the hospital visit database in Seoul, South Korea, collected between 2013 and 2017. The data set included outpatient hospital visits (n = 17,787,982), hospital admissions (n = 215,696), and emergency department visits (n = 85,482). The daily atmospheric environmental information from 2013 to 2017 at 25 locations in Seoul was evaluated. The three analysis models revealed that NO₂ was the most significant pollutant on average in outpatient hospital visits by asthma patients. For example, NO₂ had the greatest impact on outpatient hospital visits, resulting in a positive association (r=0.331). In hospital admissions of asthma patients, CO was the most significant pollutant on average. It was observed that CO exhibited the most positive association with hospital admissions (I = 3.329). Additionally, a significant time lag was found between both NO₂ and CO and outpatient hospital visits and hospital admissions of asthma patients in the linear correlation analysis. In particular, NO₂ and CO were shown to increase hospital admissions at lag 4 in the linear correlation analysis. This study provides evidence that PM_2.5, PM₁₀, NO₂, CO, SO₂, and O₃ are associated with the frequency of hospital visits by asthma patients.