Air pollution and seasonal asthma during the pollen season. A cohort study in Puertollano and Ciudad Real (Spain)

Background: Many studies have demonstrated a positive association between air pollutants and emergency visits for asthma. However, few studies have included pollen when analysing this relationship in mild-moderate asthmatic patients. Objective: To determine the importance of the pollutants such as ozone (O-3), particles (PM10), nitrogen dioxide (NO2) and sulphur dioxide (SO2) in the clinical course of mild-moderate pollen-allergic asthmatic patients from two Spanish towns in La Mancha: Puertollano (high pollution levels) and Ciudad Real (low pollution levels). Methods: We used a Poisson regression model to study a cohort of 137 patients from Puertollano and Ciudad Real during two pollen seasons (2000-2001) and analysed the relationship between air pollutant and pollen levels and daily symptoms, the medication used and peak-flow measurements. Results: The number of asthma symptoms and the mean values of the PM10, SO2 and NO2 levels were higher in Puertollano than in Ciudad Real. In Puertollano, the risk of asthma increased by 6% with a 3-day lag for PM10, by 8% with a 3-day lag for O-3, by 4% with a 1-day lag for SO2 and by 15% with a 3-day lag for O-3 when its values exceeded the health threshold (P < 0.05). Conclusions: The air pollution levels in Puertollano were associated with an increased risk of asthma symptoms in pollen-allergic asthmatic patients com pared with a similar group from Ciudad Real.