Impact of Annual Exposure to Polycyclic Aromatic Hydrocarbons on Acute Exacerbation Frequency in Asthmatic Patients

Shih-Wei Lee; Yu-Chen Huang; Chun-Yu Lin; Hung-Yu Huang; Chi-Wei Liu; Ming-Tsuen Hsieh; Chon-Lin Lee; Wen-Yu Chung; Kian Fan Chung; Chun-Hua Wang; Han-Pin Kuo

doi:10.2147/JAA.S288052

Impact of Annual Exposure to Polycyclic Aromatic Hydrocarbons on Acute Exacerbation Frequency in Asthmatic Patients

J Asthma Allergy. 2021 Jan 29:14:81-90. doi: 10.2147/JAA.S288052. eCollection 2021.

Authors

Shih-Wei Lee^#¹, Yu-Chen Huang^#^{2

3}, Chun-Yu Lin^{2

3}, Hung-Yu Huang^{2

3}, Chi-Wei Liu¹, Ming-Tsuen Hsieh⁴, Chon-Lin Lee^{4

5

6

7}, Wen-Yu Chung⁸, Kian Fan Chung⁹, Chun-Hua Wang^{2

3}, Han-Pin Kuo^{10

11}

Affiliations

¹ Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan.
² Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan.
³ College of Medicine, Chang Gung Memorial University, Taoyuan, Taiwan.
⁴ Department of Marine Environment and Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan.
⁵ Aerosol Science and Research Center, National Sun Yat-Sen University, Kaohsiung, Taiwan.
⁶ Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁷ Department of Applied Chemistry, Providence University, Taichung, Taiwan.
⁸ Department of Computer Science and Information Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan.
⁹ Experimental Studies, National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, UK.
¹⁰ Pulmonary Medicine Research Center, Taipei Medical University, Taipei, Taiwan.
¹¹ Department of Thoracic Medicine, Taipei Medical University Hospital, Taipei, Taiwan.

^# Contributed equally.

Abstract

Purpose: Exposure to polycyclic aromatic hydrocarbons (PAHs) associated with ambient air particulate matter (PM) poses significant health concerns. Increased acute exacerbation (AE) frequency in asthmatic patients has been associated with ambient PAHs, but which subgroup of patients are particularly susceptible to ambient PAHs is uncertain. We developed a new model to simulate grid-scale PM_2.5-PAH levels in order to evaluate whether the severity of asthma as measured by the Global Initiative of Asthma (GINA) levels of treatment is related to cumulative exposure of ambient PAHs.

Methods: Patients with asthma residing in the northern Taiwan were reviewed retrospectively from 2014 to 2017. PM_2.5 were sampled and analysed for PAHs twice a month over a 72-hour period, in addition to collecting the routinely monitored air pollutant data from an established air quality monitoring network. In combination with correlation analysis and principal component analysis, multivariate linear regression models were performed to simulate hourly grid-scale PM_2.5-PAH concentrations (ng/m³). A geographic information system mapping approach with ordinary kriging interpolation method was used to calculate the annual exposure of PAHs (ng/m).

Results: Among the 387 patients with asthma aged 18 to 93 (median 62), 97 subjects were treated as GINA step 5 (24%). Asthmatics in GINA 5 subgroup with high annual PAHs exposure were likely to have a higher annual frequency of any AE (1 (0-12), p<0.0001). Annual PAHs exposure was correlated with the annual frequency of any exacerbation (r=0.11, p=0.02). This was more significant in the GINA 5 subgroup (r=0.29, p=0.005) and in the GINA 5 subgroup with severe acute exacerbations (r=0.51, p=0.002). Annual PAHs exposure, severe acute exacerbation and GINA steps were independent variables that predict annual frequency of any exacerbation.

Conclusion: Asthmatic patients in the GINA 5 subgroup with acute exacerbations were more susceptible to the effect of environmental PAHs on their exacerbation frequency. Reducing environmental levels of PAHs will have the greatest impact on the more severe asthma patients.

Keywords: GINA; asthma acute exacerbation; hourly grid-scale model; polycyclic aromatic hydrocarbons.

Grants and funding

This work was supported by the Ministry of Science and Technology Research grants (MOST107-2314-B-182-074-MY3, MOST105-EPA-F-008-001 and MOST108-2611-M-110-008) and the Chang Gung Medical Research Project grants (CMRPG3F1501 and CMRPG3F1502).