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Respiration. 2004 Mar-Apr;71(2):134-7.

Visits to the emergency room for asthma attacks and short-term variations in air pollution. A case-crossover study.

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Department of Chest Diseases and Allergy, Hopital Nord, and UPRES Equipe d'Accueil No. 1784 Biogénotoxicologie et mutagénèse environnementale - IFR 112: Pôle Méditerranéen des Sciences de l'Environnement, Marseille, France.



The 'case-crossover' design is a strategy fitted to studying transient effects of intermittent exposure on acute-onset disease occurring shortly after exposure. It has the important advantage of eliminating most confounding variables, allowing a stronger causality inference.


The objective of the study was to evaluate the relationships between emergency room (ER) visits for asthma attacks and gaseous air pollution changes.


The study included 549 individuals, 3-49 years old, visiting the ER during 1 year. Exposure to gaseous air pollutants (SO2, NO2, O3) on the same day and up to 4 days before was computed according to the patient's address. The statistical analysis included meteorological data as potential confounding variables.


No association could be shown between ER visits and SO2 or NO2 levels. In contrast, there was a statistically significant association between ER visits and mean O3 levels, on the day of admission and also on D -2 and D -3. For an increase of 10 microg/m3, the risk of requiring an ER admission increased by 6-10%.


Using this new strategy, we confirmed that ozone changes lead to a moderate increase in risk of requiring an ER admission in asthmatic subjects.

[Indexed for MEDLINE]

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