The effect of short-term particular matter2.5 exposure on asthma attacks in asthma children in Fukuoka, Japan

Song Han Lee; Koh Woon Lee; Yoon Ha Hwang; Hiroshi Odajima

doi:10.7180/kmj.2018.33.2.171

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Lee, Lee, Hwang, and Odajima: The effect of short-term particular matter2.5 exposure on asthma attacks in asthma children in Fukuoka, Japan

Original Article

Kosin Medical Journal 2018;33(2):171-180.

Published online: 19 January 2018

DOI: https://doi.org/10.7180/kmj.2018.33.2.171

The effect of short-term particular matter_2.5 exposure on asthma attacks in asthma children in Fukuoka, Japan

Song Han Lee¹, Koh Woon Lee¹, Yoon Ha Hwang¹, Hiroshi Odajima²

¹Department of Pediatrics, Busan St. Mary’s Hospital, Busan, Korea

²Department of Pediatrics, Fukuoka National Hospital, Japan, Korea

Corresponding Author: Lee Song Han, Department of Pediatrics, Busan St. Mary’s Hospital 25-14, Yongho-ro, 232 beon-gil, Nam-gu, Busan 48575, Korea Tel: +82-52-246-6113 Fax: +82-52-246-6113 E-mail: thdgks33@naver.com

Received 21 September 201620 October 2016 Accepted 24 October 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

We investigated whether asthma attacks in asthmatic children were caused by short-term exposure to particulate matter(PM)_2.5.

Methods

Subjects were 411 patients who received inhalation therapy in National Fukuoka Hospital, from March to May 2013. All subjects were outpatients. We surveyed the air quality measurement results in the stations closest to the address of the patients. Data were used from the City of Fukuoka website data on air pollution. We carried out a case-crossover study and compared PM_2.5 concentration between 7 days after asthma attack occurred and the day asthma attack occurred and 1, 2 and 3 days before asthma attack occurred.

Results

Highest hourly concentration of the day (OR 1.013, 95%CI 1.000-1.025) showed a significant association with 1 day before PM_2.5 concentration statistically. And 0-1 year-old infants were more vulnerable to the highest concentration of 1 day before PM_2.5 concentration(P < 0.05). Average concentration of NO₂ and O₃ and asthma attack also showed a significant association.

Conclusions

Maximal daily PM_2.5 concentrations within 24 hours prior to the attack affect asthma exacerbation. 0-1 year-old infants are particularly vulnerable to PM_2.5 concentration. Asthma exacerbation is aggravated by NO₂ and O₃ concentration on the day of the asthma attack.

Keywords: Air pollution, Asthma, Asthma attack, Japan

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Fig. 1.

Map of monitoring stations in Fukuoka. The table on the left shows the names of monitoring stations, the number of asthma patients, and percentage.

Table 1.

Characteristics of the study groups.

	Number	Percent
Total	411
Sex ratio (M:F)	1.45
Mean age(± SD)	5.58 ± 4.41
Age
0-1	97	23.6
2-5	142	34.5
6-12	136	33.1
13-15	30	7.3
Over 16	6	1.5

Table 2.

Comparison of maximal, average concentration of PM_2.5 (μg/㎥).

	D-3‡	Control day	D-2§	Control day
Average(maximal)	35.65	36.50	35.52	33.91
Standard deviation	18.53	19.34	18.73	16.81
P		0.522		0.196
	D-1∥	Control day	D0¶	Control day
Average(maximal)	35.44	32.84	35.71	34.53
Standard deviation	18.22	15.63	18.19	18.23
P		0.029		0.352
	D-3‡	Control day	D-2§	Control day
Average(average)	22.21	22.92	21.81	21.47
Standard deviation	12.33	13.98	11.54	12.64
P		0.439		0.684
	D-1∥	Control day	D0¶	Control day
Average(average)	21.34	19.81	21.95	21.17
Standard deviation	11.89	11.00	13.06	12.43
P		0.057		0.382

^* P < 0.01

^† P < 0.05 by t-test

^‡ D-3 : 3 days prior to day of attack

^§ D-2 : 2 days prior to day of attack

^∥ D-1 : 1 day prior to day of attack

^¶ D0 : day of asthma attack

Table 3.

Odds ratios and 95% confidence intervals of asthma attack by maximal 1-hour concentration of each air pollutant.

		D-3‡			D-2§
		OR*	95%CI†	P	OR*	95%CI†	P
PM_2.5	Single-variant	0.998	0.990-1.005	0.522	1.005	0.997-1.013	0.196
	Multi-variant	0.841	0.719-0.983	0.030	0.932	0.844-1.029	0.165
SPM	Single-variant	0.993	0.986-1.000	0.067	0.998	0.990-1.006	0.579
	Multi-variant	1.160	1.037-1.297	0.009	1.060	0.981-1.146	0.142
NO₂	Single-variant	1.004	0.988-1.021	0.615	1.013	0.997-1.029	0.105
	Multi-variant	0.973	0.885-1.069	0.564	1.101	1.012-1.197	0.026
O₃	Single-variant	0.984	0.971-0.997	0.197	0.986	0.972-0.999	0.042
	Multi-variant	1.174	1.089-1.264	0.000	1.043	0.995-1.094	0.081
		D-1∥			D0¶
		OR*	95%CI†	P	OR*	95%CI†	P
PM_2.5	Single-variant	1.009	1.001-1.017	0.030	1.004	0.996-1.011	0.352
	Multi-variant	1.063	0.944-1.195	0.313	0.954	0.874-1.040	0.286
SPM	Single-variant	1.004	0.996-1.012	0.318	1.002	0.995-1.009	0.598
	Multi-variant	0.992	0.903-1.090	0.874	1.027	0.968-1.090	0.380
NO₂	Single-variant	1.016	1.000-1.033	0.052	1.010	0.995-1.026	0.197
	Multi-variant	1.001	0.922-1.086	0.984	1.111	0.944-1.308	0.207
O₃	Single-variant	1.003	0.988-1.019	0.661	1.015	0.999-1.030	0.065
	Multi-variant	0.920	0.860-0.985	0.016	1.011	0.965-1.056	0.646

^* OR : odds ratio

^† CI : confidence interval

^‡ D-3 : 3 days prior to day of attack

^§ D-2 : 2 days prior to day of attack

^∥ D-1 : 1 day prior to day of attack

^¶ D0 : day of asthma attack

Table 4.

Odds ratios and 95% confidence intervals of asthma attack by average daily concentration of each air pollutant.

		D-3‡			D-2§
		OR*	95%CI†	P	OR*	95%CI†	P
PM_2.5	Single-variant	0.996	0.986-1.006	0.439	1.002	0.991-1.014	0.683
	Multi-variant	0.777	0.564-1.072	0.124	1.052	0.880-1.257	0.581
SPM	Single-variant	0.992	0.981-1.002	0.133	0.994	0.983-1.005	0.304
	Multi-variant	1.299	0.963-1.752	0.086	0.977	0.854-1.117	0.729
NO₂	Single-variant	0.993	0.961-1.027	0.692	1.013	0.978-1.049	0.467
	Multi-variant	0.815	0.601-1.103	0.185	1.271	1.027-1.572	0.027
O₃	Single-variant	1.006	0.989-1.024	0.481	0.994	0.975-1.013	0.513
	Multi-variant	1.475	1.179-1.846	0.001	1.128	1.031-1.234	0.009
		D-1∥			D0¶
		OR*	95%CI†	P	OR*	95%CI†	P
PM_2.5	Single-variant	1.012	1.000-1.024	0.057	1.005	0.994-1.016	0.382
	Multi-variant	1.068	0.907-1.259	0.430	1.004	0.893-1.129	0.941
SPM	Single-variant	1.009	0.997-1.020	0.133	1.004	0.993-1.014	0.506
	Multi-variant	0.952	0.835-1.085	0.456	0.974	0.894-1.063	0.558
NO₂	Single-variant	1.018	0.985-1.052	0.299	1.034	1.002-1.068	0.040
	Multi-variant	1.078	0.926-1.255	0.331	1.103	0.942-1.292	0.224
O₃	Single-variant	1.016	0.997-1.035	0.097	1.031	1.012-1.050	0.001
	Multi-variant	1.037	0.960-1.120	0.359	1.058	0.990-1.131	0.098

^* OR : odds ratio

^† CI : confidence interval

^‡ D-3 : 3 days prior to day of attack

^§ D-2 : 2 days prior to day of attack

^∥ D-1 : 1 day prior to day of attack

^¶ D0 : day of asthma attack

Table 5.

Odds ratios and 95% confidence intervals of asthma attack by maximal 1-hour concentration of PM_2.5 divided by age group.

Age group (years)	Odds ratio	95% Confidence interval	P-value
0-1	1.018	1.001-1.035	0.042
2-5	1.002	0.988-1.017	0.757
6-12	1.007	0.993-1.021	0.345
13-15	1.022	0.993-1.052	0.139
Over 16	0.987	0.879-1.108	0.822

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