Seasonal variation in bronchial reactivity in a community population

doi:10.1016/0091-6749(88)90063-2

Journal of Allergy and Clinical Immunology

Volume 82, Issue 1, July 1988, Pages 134-139

https://doi.org/10.1016/0091-6749(88)90063-2 Get rights and content

Abstract

Morbidity and mortality from asthma is increased during the grass-pollen season and during the autumn months in the United Kingdom. It is not apparent why this seasonal variation occurs nor whether the variation in morbidity and mortality is associated with variation in bronchial reactivity. We have measured bronchial reactivity on four occasions during 12 months in 60 subjects selected from a community population in the south of England. All subjects had had a histamine challenge test and skin tests to common antigens as part of a survey of asthma prevalence in March 1984. Further measurements of the provocative dose causing a 20% fall in FEV₁ (PD₂₀) were made at the peak of the grass-pollen season in June, at the end of September, and in the following March, and current symptoms of respiratory tract infection (RTI) were assessed on all four occasions. Geometric mean PD₂₀ demonstrated significant seasonal variation between 1.38, 0.82, 0.92, and 1.20 μmol in March, June, September, and March, respectively (p < 0.02). Relative to March 1984, PD₂₀ was significantly decreased in June and September (p < 0.005 and p < 0.02, respectively) but not in March 1985 (p = 0.39). Within subjects atopy was significantly related to decrease in PD₂₀ in September (p < 0.05) and in March 1985 (p < 0.025) but not in June (p = 0.40). Change in PD₂₀ between occasions was unrelated to RTI symptoms, age, or smoking status, but it was related to change in baseline $FEV_{1} FVC (p < 0.001)$ . In this study seasonal increases in bronchial reactivity occurred in the general population at times when asthma morbidity and mortality are increased. Increased bronchial reactivity was not associated with RTI symptoms. The increase in bronchial reactivity in September was related to atopy, but the increase in June was not.

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The worldwide increase in the incidence, prevalence, and severity of asthma may suggest that environmental factors play a role in these epidemiologic changes.
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One-year prospective study. Data of daily concentration of air pollutants, weather conditions, and selective airborne allergens were collected and compared with the number of ER visits of asthmatic children.
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Correlations between fluctuations in ER visits of asthmatic children and various environmental parameters were more relevant for weekly than for daily values. Emergency room visits correlated positively with concentrations of NO_x, SO₂ and with high barometric pressure; and negatively with O₃ concentration and minimal and maximal temperature. There were no significant correlations with concentrations of particulates, humidity, or airborne pollen and spores. An exceptionally high incidence of ER visits of asthmatic children was observed during September. This peak coincided with the beginning of the school year and the Jewish holidays. The correlations between ER visits and the environmental factors increased significantly when the September peak was excluded, revealing that 61% of the variance in ER visits was explained by NO_x, SO₂, and O₃ concentrations, 46% by weather parameters, 66% by NO_x, SO₂ and barometric pressure, and a 69% by the combination of air pollutants and weather parameters.
The major factors found to be associated with ER visits of asthmatic children were high NO_x, high SO₂, and high barometric pressure. Negative correlation was found between ER visits of asthmatic children and ozone concentrations. The particularly high number of ER visits at the beginning of the school year and the Jewish holidays was probably associated with an increase in the number of viral infections and/or emotional stress.
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Reproducibility of methacholine inducedbronchoconstriction in healthy subjects: the use of area under the expiratory flow-volume curve to express results
1990, Respiratory Medicine
The usefulness of the pulmonary function variable, area under the expiratory flow-volume curve (AEFV), inmethacholine provocation (MP) studies in normal subjects was evaluated. The baseline coefficients of variation (CV), maximal fall from post-saline values (MAX) and dose-response slope [DRS=maximal percentage fall in pulmonary function/maximal noncumulativ methacholine dose (μmol)] were calculated for AEFV, and were compared to those of forced expiratory volume in one second (FEV₁), maximum expiratory flow at 50% (MEF_50%) and at 25% (MEF_25%). Also the repeatability after 2 and 8 weeks was assessed. The rank order of CVs was FEV₁<AEFV<MEF_50%≈MEF_25% all differences, except MEF_50%vs. MEF_25%, being significant (P<0·05). The order of sensitivities (estimated with MAX and DRS) was FEV₁<AEFV<MEF_50%<MEF_50%. Again, all differences were significant (AEFV vs. MEF_50%P<0·01, others P<0·001). After two weeks the correlation coefficients for MAX- and DRS-values of AEFV were 0·84 and 0·94 (P<0·001), respectively. After an eight week period tended to be smaller than eight weeks before. The repeatability of MAX of AEFV was not quite as high as that of FEV₁. On the other hand, the correlations of DRS-value derived from AEFV were markedly better than those derived from FEV₁. In conclusion, MP in normal subjects is well repeatable at least within two weeks, but after an eight week period disturbing factors may intervene reducing repeatability. AEFV can be considered at least as good a pulmonary function variable as FEV₁ in demonstrating bronchoconstriction during MPs in normal subjects, and it might even be a better variable to obtain DRS-values than other variables tested.

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^☆: Supported by a grant from the Department of Health and Social Security.

¹: From the Respiratory Medicine Unit, City Hospital, Nottingham.

^∗: From the Department of Community Medicine, United Medical and Dental Schools of Guys and St Thomas Hospitals, London, England.

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Original articleSeasonal variation in bronchial reactivity in a community population☆

Abstract

J Allergy

Lancet

J Allergy Clin Immunol

Lancet

Br J Dis Chest

J Allergy Clin Immunol

Chest

J Allergy Clin Immunol

J Allergy Clin Immunol

Detection of asthma epidemics in seven cities

Arch Environ Health

Bronchial asthma in children and its occurrence in relation to weather pollution

Ann Allergy

Asthma and the Brisbane climate

Aust NZ J Med

Assessment and management of asthma in an accident and emergency department

Thorax

Seasonal variation and time trend in asthma mortality in England and Wales

Br Med J

Seasonal trends in childhood asthma in southeast England

Br Med J

Trends in asthma and hay fever in general practice in the United Kingdom 1976–1983

Thorax

Influence of weather and climate on asthma and bronchitis

Rev Allergy

Asthma and temperature change

Arch Environ Health

Asthma and climatic conditions: experience from Bermuda, an isolated island community

Br Med J

The epidemiological and allergic features of asthma in the New Guinea Highlands

Clin Allergy

Possible role of basidiospores as airborne allergens

Nature

Original article
Seasonal variation in bronchial reactivity in a community population☆