Neighborhood air pollution and household environmental health as it relates to respiratory health and healthcare utilization among elderly persons with asthma

Abstract

Objective: The study investigated the associations between fine particulate matter (PM_2.5; <2.5 μm in diameter), indoor environment, pulmonary function, and healthcare utilization in a vulnerable group of elderly persons with asthma. We hypothesized that environmental conditions were associated with adverse pulmonary health outcomes. Methods: The study involved elderly (n = 76; mean age 64.6 years; 48 women) vulnerable persons in Detroit, Michigan, USA, with physician-diagnosed asthma. Exposure variables included measured outdoor PM_2.5, self-rated outdoor and household environmental pollutants. Outcome variables were self-rated and measured pulmonary function, and asthma-related healthcare utilization. Results: Mean ambient PM_2.5 concentrations during the study was 14.14 ± (S.D. 6.36) µg/m³ during the summer and 14.20 (6.33) during the winter (p = 0.95). In multiple regression analyses, adjusting for age and gender, mean 6-month concentration of PM_2.5 was related to shortness of breath (SHOB; standardized β = 0.26, p = 0.02) and inversely with self-rated respiratory health (SRRH; β = 0.28, p = 0.02). However, PM_2.5 did not predict lung function (FEV₁% predicted and FEV₁/FVC). However, PM_2.5 was related to use of asthma controller drugs (β = 0.38, p = 0.001). Participants’ air pollution ratings predicted total healthcare utilization (β = 0.33, p = 0.01). Conclusions: In elderly persons with asthma, living near heavy industry and busy highways, objective and perceived environmental pollution relate to participants’ respiratory health and healthcare utilization. Importantly, air pollution might increase use of asthma controller drugs containing corticosteroids with implication for elderly persons’ risk to develop osteoporosis and cardiovascular disease.

Keywords:

• Environmental exposures
• pulmonary function
• asthma exacerbation
• asthma drug use

Acknowledgments

Sincere thanks are due to all our participants that committed their time and efforts to this study and shared their experience with the research team. We also would like to thank Evone Barkho, MB, ChB, MPH, Ahalm Al Zindadni, RN, and Walid Mohamed, RN, for diligently carrying out all the phases of the projects. We would like to thank Dr. Steven Pierce for providing the team with invaluable statistical advice, although the study team takes full responsibility for any statistical shortcomings. Finally, we would like to thank our community partner ACCESS that plays a critical role in our environmental health studies in Dearborn.

Disclosure statement

The authors report no conflict of interest.

Additional information

Funding

Funding was provided by a competitive grant from Michigan University Research Corridor, URC, which is gratefully acknowledged.