Article Text

Fine particulate pollution and asthma exacerbations
  1. Naïm Bouazza1,2,
  2. Frantz Foissac1,2,
  3. Saik Urien1,2,
  4. Romain Guedj3,
  5. Ricardo Carbajal3,
  6. Jean-Marc Tréluyer1,2,
  7. Hélène Chappuy2,3
  1. 1Pharmacology and Clinical Research Departments, Paris Descartes Necker Cochin, Assistance Publique – Hopitaux de Paris, Paris, France
  2. 2Pharmacology and Drug Evaluation in Children and Pregnant Women EA7323, Paris Descartes University, Sorbonne Paris Cité, Paris, France
  3. 3Pediatric Emergency Department, Armand Trousseau Hospital, APHP, Pierre and Marie Curie University, Paris, France
  1. Correspondence to Professor Hélène Chappuy, Pediatric Emergency Department, Armand Trousseau Hospital, APHP, Pierre and Marie Curie University, Paris, France; helene.chappuy{at}


Objective As the results from epidemiological studies about the impact of outdoor air pollution on asthma in children are heterogeneous, our objective was to investigate the association between asthma exacerbation in children and exposure to air pollutants.

Methods A database of 1 264 585 paediatric visits during the 2010–2015 period to the emergency rooms from 20 emergency departments (EDs) of ‘Assistance Publique Hôpitaux de Paris (APHP)’, the largest hospital group in Europe, was used. A total of 47 107 visits were classified as asthma exacerbations. Concentration of air pollutants (nitrogen dioxide, ozone, fine particulate matter (PM) with an aerodynamic diameter smaller than 10  µm (PM10) and 2.5 µm (PM2.5)), as well as meteorological data, evolution of respiratory syncytial virus infection and pollen exposition, were collected on an hourly or daily basis for the same period using institutional databases. To assess the association between air pollution and asthma, mixed-effects quasi-Poisson regression modelling was performed.

Results The only compound independently associated with ED visits for asthma was PM2.5 (P<10−4). The association between asthma exacerbation and PM2.5 was not linear, and a sigmoid function described the relationshipsatisfactorily. PM2.5 concentration, which gives half the maximum effect, was estimated at 13.5 µg/m3.

Conclusions We found an association between daily asthma exacerbation in paediatric visits to the ED and fine particulate air pollutants.

  • general paediatrics

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  • Contributors HC, RG, RC conceptualised and designed the study, drafted the initial manuscript and revised the manuscript. NB, FF, SU conceptualised and designed the study, carried out the initial analyses, and reviewed and revised the manuscript. JMT designed the data collection instruments, coordinated and supervised data collection, and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

  • Competing interests None declared.

  • Ethics approval The study was approved by the ethics committee of Necker-Enfants Malades Hospital (Paris).

  • Provenance and peer review Not commissioned; internally peer reviewed.

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