Impact of annual exposure to polycyclic aromatic hydrocarbons on acute exacerbation frequency in asthmatic patients

Shih Wei Lee, Yu Chen Huang, Chun Yu Lin, Hung Yu Huang, Chi Wei Liu, Ming Tsuen Hsieh, Chon Lin Lee, Wen Yu Chung, Kian Fan Chung, Chun Hua Wang*, Han-Ping Kuo*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

5 Scopus citations


Purpose: Exposure to polycyclic aromatic hydrocarbons (PAHs) associated with ambient air particulate matter (PM) poses significant health concerns. Increased acute exacerbation (AE) frequency in asthmatic patients has been associated with ambient PAHs, but which subgroup of patients are particularly susceptible to ambient PAHs is uncertain. We developed a new model to simulate grid-scale PM2.5-PAH levels in order to evaluate whether the severity of asthma as measured by the Global Initiative of Asthma (GINA) levels of treatment is related to cumulative exposure of ambient PAHs. Methods: Patients with asthma residing in the northern Taiwan were reviewed retrospectively from 2014 to 2017. PM2.5 were sampled and analysed for PAHs twice a month over a 72-hour period, in addition to collecting the routinely monitored air pollutant data from an established air quality monitoring network. In combination with correlation analysis and principal component analysis, multivariate linear regression models were performed to simulate hourly grid-scale PM2.5-PAH concentrations (ng/m3). A geographic information system mapping approach with ordinary kriging interpolation method was used to calculate the annual exposure of PAHs (ng/m). Results: Among the 387 patients with asthma aged 18 to 93 (median 62), 97 subjects were treated as GINA step 5 (24%). Asthmatics in GINA 5 subgroup with high annual PAHs exposure were likely to have a higher annual frequency of any AE (1 (0–12), p<0.0001). Annual PAHs exposure was correlated with the annual frequency of any exacerbation (r=0.11, p=0.02). This was more significant in the GINA 5 subgroup (r=0.29, p=0.005) and in the GINA 5 subgroup with severe acute exacerbations (r=0.51, p=0.002). Annual PAHs exposure, severe acute exacerbation and GINA steps were independent variables that predict annual frequency of any exacerbation. Conclusion: Asthmatic patients in the GINA 5 subgroup with acute exacerbations were more susceptible to the effect of environmental PAHs on their exacerbation frequency. Reducing environmental levels of PAHs will have the greatest impact on the more severe asthma patients.

Original languageEnglish
Pages (from-to)81-90
Number of pages10
JournalJournal of Asthma and Allergy
StatePublished - 2021

Bibliographical note

Publisher Copyright:
© 2021 Lee et al.


  • Asthma acute exacerbation
  • GINA
  • Hourly grid-scale model
  • Polycyclic aromatic hydrocarbons


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