New research examines the link between the Air Quality Index and pediatric asthma exacerbations that require hospitalization.

“There is a wealth of data demonstrating that outdoor air pollution harms children with asthma, but how to incorporate this data into clinical practice is less clear. Guidelines appropriately recommend that health care providers discuss outdoor air pollution, but we don’t have evidence-based guidelines about what air index we should use or a definition of ‘high’ air pollution,” Franziska Rosser, MD, MPH, assistant professor of pediatrics in the division of pulmonology at UPMC Children’s Hospital of Pittsburgh at the University of Pittsburgh, told Healio.

“Many pollutants don’t have known ‘safe’ levels, and several studies in children with asthma have shown that asthma can get worse even at levels below national air standards. In the United States, the Environmental Protection Agency designed the Air Quality Index (AQI), which alerts the public to the air quality and provides recommendations of what to do when the air quality is poor.”

Rosser and colleagues aimed to evaluate the association between the AQI and asthma exacerbations in children. The retrospective, time-stratified, case-crossover study used medical records from UPMC Children’s Hospital of Pittsburgh from 2010 to 2018 for children aged 6 to 17 years with an asthma exacerbation, which was defined as an ED visit or hospitalization for asthma. Average age at the time of exacerbation was 10 years. Most children (64%) had one exacerbation event, but most events occurred in children with multiple exacerbations during the study period. Exacerbation resulted in an ED visit in more than 99% of cases. Black children had more exacerbation events compared with white children (65% vs. 31% of events). Researchers collected daily AQI data for Allegheny County, Pennsylvania.

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