Short-term effects of multiple outdoor environmental factors on risk of asthma exacerbations: Age-stratified time-series analysis

Seung Won Lee, Dong Keon Yon, Chase C. James, Shinhae Lee, Hyun Yong Koh, Youn Ho Sheen, Jae Won Oh, Man Yong Han, George Sugihara

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4 Scopus citations


Background: Although the different age groups had differences in sensitivity of asthma exacerbations (AEs) to environmental factors, no comprehensive study has examined the age-stratified effects of environmental factors on AEs. Objective: We sought to examine the short-term effects in age-stratified groups (infants, preschool children, school-aged children, adults, and the elderly) of outdoor environmental factors (air pollutants, weather conditions, aeroallergens, and respiratory viral epidemics) on AEs. Methods: We performed an age-stratified analysis of the short-term effects of 4 groups of outdoor environmental factors on AEs in Seoul Metropolitan City (Korea) from 2008 and 2012. The statistical analysis used a Poisson generalized linear regression model, with a distributed lag nonlinear model for identification of lagged and nonlinear effects and convergent cross-mapping for identification of causal associations. Results: Analysis of the total population (n = 10,233,519) indicated there were 28,824 AE events requiring admission to an emergency department during the study period. Diurnal temperature range had significant effects in pediatric (infants, preschool children, and school-aged children) and elderly (relative risk [RR], 1.056-1.078 and 1.016, respectively) subjects. Tree and weed pollen, human rhinovirus, and influenza virus had significant effects in school-aged children (RR, 1.014, 1.040, 1.042, and 1.038, respectively). Tree pollen and influenza virus had significant effects in adults (RR, 1.026 and 1.044, respectively). Outdoor air pollutants (particulate matter of ≤10 μm in diameter, nitrogen dioxide, ozone, carbon monoxide, and sulfur dioxide) had significant short-term effects in all age groups (except for carbon monoxide and sulfur dioxide in infants). Conclusion: These findings provide a need for the development of tailored strategies to prevent AE events in different age groups.

Original languageEnglish
Pages (from-to)1542-1550.e1
JournalJournal of Allergy and Clinical Immunology
Issue number6
StatePublished - 2019 Dec


  • Asthma exacerbation
  • aeroallergen
  • air pollutant
  • human rhinovirus
  • influenza virus
  • weather condition

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