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Abstract
Purpose
The evidence for a causal relationship between high-level ozone (O3) exposure and acute exacerbation of asthma among adults is limited, and the conclusions are less definitive.
Patients and methods
Here we collected the daily data on asthma cases, O3 exposure, and meteorological factors from 2010 to 2016 in Shijiazhuang, China. We investigated the risk of asthma exacerbation associated with high-level ozone exposure using a polynomial distributed lag model (PDLM). Using a generalized additive model (GAM), we estimated the interactive effects between O3 and other pollutants as well as meteorological factors on asthma exacerbation.
Results
A total of 7270 patients with asthma were enrolled from 22 governmental hospitals in 13 counties. Each 10 μg/m3 increase in O3 concentration on the exacerbation of asthma was associated with a 1.92% (95% CI = 0.80–3.03%) higher risk of asthma exacerbation on day lag 7. The cumulative risk of O3 on asthma exacerbation increased by 18.9% (95% CI = 12.8–25.4%) on the 14th day. High consecutive levels of O3 increase the risk of asthma exacerbation, and the interactive effect of O3 and sulfur dioxide (SO2) appears before the exacerbation onset.
Conclusion
These findings suggested that O3 should be an important risk factor for asthma exacerbation, and health benefits in reducing asthma exacerbation risk would be gained with continued efforts to improve the air quality in China.
Ethics Approval and Consent to Participate
The work described was carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki), approved by the Ethics Committee of the Hebei Province Hospital of Traditional Chinese Medicine. Written informed consent was assent obtained from all participants prior to enrollment.
Acknowledgments
We would like to thank Hebei Environmental Protection Bureau and Hebei Meteorological Bureau for sharing the data needed for this study.
Disclosure
The authors report no conflicts of interest in this work.