The role of outdoor fungi on asthma hospital admissions in children and adolescents: a 5-year time stratified case-crossover analysis

Journal article


Tham, Rachel, Katelaris, Constance H., Vicendese, Don, Dharmage, Shyamali C., Lowe, Adrian J., Bowatte, Gayan, Taylor, Philip, Burton, Pamela, Abramson, Michael J. and Erbas, B.. (2017). The role of outdoor fungi on asthma hospital admissions in children and adolescents: a 5-year time stratified case-crossover analysis. Environmental Research. 154, pp. 42 - 49. https://doi.org/10.1016/j.envres.2016.12.016
AuthorsTham, Rachel, Katelaris, Constance H., Vicendese, Don, Dharmage, Shyamali C., Lowe, Adrian J., Bowatte, Gayan, Taylor, Philip, Burton, Pamela, Abramson, Michael J. and Erbas, B.
Abstract

Background
Some fungal spores can trigger asthma exacerbation but knowledge of which outdoor fungal spores contribute to asthma hospitalisation is limited.
Objectives
To examine the role of outdoor fungal spores in child and adolescent asthma hospitalisations.
Methods
We conducted a bi-directional time-stratified case-crossover study of child and adolescent asthma hospitalisations over 5 years. Conditional logistic regression assessed the role of 20 fungi taxa (Same day [L0] and lagged [L1-3]) adjusted for maximum temperature, humidity and grass pollen. Strata specific effects were explored if there was evidence of effect modification by age, sex, air pollutants or grass pollen. Non-linear effects examined with Generalized Additive Models.
Results
Of 2098 children hospitalised for asthma, 60% were boys; mean age was 5.5±3.7 years. Fungal spore counts peaked during warm months. Regression models found weak associations with Coprinus [L0,L1: OR=1.03, 1.01–1.06], Periconia [L0: OR=1.03, 1.001–1.07] and Chaetomium [L2: OR=1.08, 1.0–1.2]. Sex appeared to act as an effect modifier with girls having stronger associations with Cladosporium, Coprinus and total fungi. Older adolescent (14–18 years) hospitalisation was significantly associated with Coprinus and Ustilago/smuts. Air pollutants and grass pollen did not appear to act as effect modifiers. Non-linearity was not detected.
Conclusion
There may be associations between some outdoor fungal spores and asthma hospitalisations. Further research needed to explore whether these findings can be replicated; and examine whether fungal sensitisation and/or human rhinovirus infections are associated with stronger effects. If findings are replicated, then the need to develop predictive models for fungal spore distribution and levels may become more important.

KeywordsChild; Adolescent; Asthma; hospitalisations; Outdoor fungi; Case cross-over
Year2017
JournalEnvironmental Research
Journal citation154, pp. 42 - 49
PublisherAcademic Press
ISSN0013-9351
Digital Object Identifier (DOI)https://doi.org/10.1016/j.envres.2016.12.016
Scopus EID2-s2.0-85007251520
Page range42 - 49
Research GroupMary MacKillop Institute for Health Research
Publisher's version
File Access Level
Controlled
Place of publicationUnited States of America
EditorsJ. L. Domingo
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