Pollen exposure and hospitalization due to asthma exacerbations: daily time series in a European city

Abstract

Exposure to pollen can contribute to increased hospital admissions for asthma exacerbation. This study applied an ecological time series analysis to examine associations between atmospheric concentrations of different pollen types and the risk of hospitalization for asthma in London from 2005 to 2011. The analysis examined short-term associations between daily pollen counts and hospital admissions in the presence of seasonal and long-term patterns, and allowed for time lags between exposure and admission. Models were adjusted for temperature, precipitation, humidity, day of week, and air pollutants. Analyses revealed an association between daily counts (continuous) of grass pollen and adult hospital admissions for asthma in London, with a 4-5-day lag. When grass pollen concentrations were categorized into Met Office pollen 'alert' levels, 'very high' days (vs. 'low') were associated with increased admissions 2-5 days later, peaking at an incidence rate ratio of 1.46 (95%, CI 1.20-1.78) at 3 days. Increased admissions were also associated with 'high' versus 'low' pollen days at a 3-day lag. Results from tree pollen models were inconclusive and likely to have been affected by the shorter pollen seasons and consequent limited number of observation days with higher tree pollen concentrations. Future reductions in asthma hospitalizations may be achieved by better understanding of environmental risks, informing improved alert systems and supporting patients to take preventive measures.

Keywords: Air pollution; Asthma; Grass pollen; Pollen; Time series; Tree pollen.

Fig. 1

Locations of pollen and air quality monitors, within London Government Office Region

Fig. 2

Conceptual framework for the exposure-outcome pathway, outlining the conceptual framework underpinning the analytical approach (model accounts for day of week (plus public holiday) effect)

Fig. 3

Predicted asthma admissions (95% CI) at representative grass pollen counts at 4-day and 5-day lags