Do respiratory virus infections modify associations of asthma exacerbation with aeroallergens or fine particulate matter? A time series study in Philadelphia PA

ABSTRACT

Respiratory virus infections are related to over 80% of childhood asthma exacerbations. They enhance pro-inflammatory mediator release, especially for sensitized individuals exposed to pollens/molds. Using a time-series study design, we investigated possible effect modification by respiratory virus infections of the associations between aeroallergens/PM_2.5 and asthma exacerbation rates. Outpatient, emergency department (ED), and inpatient visits for asthma exacerbation among children with asthma (28,540/24,444 [warm/cold season]), as well as viral infection counts were obtained from electronic health records of the Children’s Hospital of Philadelphia from 2011 to 2016. Rate ratios (RRs, 90th percentile vs. 0) for late-season grass pollen were 1.00 (0.85–1.17), 1.04 (0.95–1.15), and 1.12 (0.96–1.32), respectively, for respiratory syncytial virus (RSV) counts within each tertile. However, similar trends were not observed for weed pollens/molds or PM_2.5. Overall, our study provides little evidence supporting effect modification by respiratory viral infections.

KEYWORDS:

• Respiratory virus
• aeroallergens
• PM_2.5
• effect modification
• childhood asthma exacerbation

Acknowledgements

This study is part of the Pediatric Big Health Data initiative funded by the State of Pennsylvania and led by the Children’s Hospital of Philadelphia, University of Pennsylvania, and the Urban Health Collaborative at Drexel University. We would like to thank the investigators of the Pediatric Big Health Data initiative for their contributions. These individuals include Christopher B. Forrest, MD, PhD; L. Charles Bailey, MD, PhD; Shweta P. Chavan, MSEE; Rahul A. Darwar, MPH; Jillian Benedetti, MPH; Daniel Forsyth; Chén C. Kenyon, MD, MSHP; Ritu Khare, PhD; Mitchell G. Maltenfort, PhD; Aaron J. Masino, PhD, ME; Xueqin Pang, PhD; Ting Qian, PhD; Hanieh Razzaghi, MPH; Justine Shults, PhD; Levon H. Utidjian, MD, MBI from the Children’s Hospital of Philadelphia; Ana V. Diez Roux, MD, PhD, MPH; Amy H. Auchincloss, PhD, MPH; Elizabeth A. Campbell, MSPH; Kimberly Daniels, MS; Anneclaire J. De Roos, PhD, MPH; J. Felipe Garcia-Espana, MS, PhD; Irene Headen, PhD, MS; Félice Lê-Scherban, PhD, MPH; Steven Melly, MS, MA; Yvonne L. Michael, ScD, SM; Jeffrey Moore, MS; Kari Moore, MS; Abigail E. Mudd, MPH; Leah Schinasi, PhD, MSPH; and Yuzhe Zhao, MS, from Drexel University, and Yong Chen, PhD; John H. Holmes, PhD; Rebecca A. Hubbard, PhD; A. Russell Localio, JD, MPH, PhD from the University of Pennsylvania.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplemental data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/09603123.2023.2299249.

Additional information

Funding

This work was supported by a grant from the Commonwealth Universal Research Enhancement (C.U.R.E) program funded by the Pennsylvania Department of Health - 2015 Formula award - SAP #4100072543.