title: Air pollution and asthma control in the Epidemiological study on the Genetics and Environment of Asthma.
abstract: BACKGROUND
  The associations between exposure to air pollution and asthma control are not well known. The objective of this study was to assess the association between long-term exposure to NO(2), O(3) and PM(10) and asthma control in the follow-up of the Epidemiological study on the Genetics and Environment of Asthma (EGEA2) (2003-2007).
  
  
  METHODS
  Modelled outdoor NO(2), O(3) and PM(10) estimates were linked to each residential address using the 4 km grid air pollutant surface developed by the French Institute of Environment in 2004. Asthma control was assessed in 481 subjects with current asthma using a multidimensional approach following the 2006-2009 Global Initiative for Asthma guidelines. Multinomial and ordinal logistic regressions were conducted adjusted for sex, age, body mass index, education, smoking and use of inhaled corticosteroids. The association between air pollution and the three domains of asthma control (symptoms, exacerbations and lung function) was assessed. ORs are reported per IQR.
  
  
  RESULTS
  Median concentrations (in micrograms per cubic metre) were 32 (IQR 25-38) for NO(2) (n=465), 46 (41-52) for O(3) and 21 (18-21) for PM(10) (n=481). In total, 44%, 29% and 27% had controlled, partly controlled and uncontrolled asthma, respectively. The ordinal ORs for O(3) and PM(10) with asthma control were 1.69 (95% CI 1.22 to 2.34) and 1.35 (95% CI 1.13 to 1.64), respectively. When including both pollutants in the same model, both associations persisted. Associations were not modified by sex, smoking status, use of inhaled corticosteroids, atopy, season of examination or body mass index. Both pollutants were associated with each of the three main domains of control.
  
  
  CONCLUSIONS
  The results suggest that long-term exposure to PM(10) and O(3) is associated with uncontrolled asthma in adults, defined by symptoms, exacerbations and lung function.
authors.affiliation: Epidémiologie respiratoire et environnementale, CESP/UMRS 1018 Inserm, UPS11, 16, avenue Paul Vaillant Couturier, 94807 Villejuif Cedex, France. benedicte.jacquemin@inserm.fr
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Jacquemin
authors.forename: Francine
authors.initials: F
authors.lastname: Kauffmann
authors.forename: Isabelle
authors.initials: I
authors.lastname: Pin
authors.forename: Nicole
authors.initials: N
authors.lastname: Le Moual
authors.forename: Jean
authors.initials: J
authors.lastname: Bousquet
authors.forename: Frédéric
authors.initials: F
authors.lastname: Gormand
authors.forename: Jocelyne
authors.initials: J
authors.lastname: Just
authors.forename: Rachel
authors.initials: R
authors.lastname: Nadif
authors.forename: Christophe
authors.initials: C
authors.lastname: Pison
authors.forename: Daniel
authors.initials: D
authors.lastname: Vervloet
authors.forename: Nino
authors.initials: N
authors.lastname: Künzli
authors.forename: Valérie
authors.initials: V
authors.lastname: Siroux
mesh_terms: D000328:Adult; D000393:Air Pollutants / Q000009:adverse effects* / Q000032:analysis; D001249:Asthma / Q000453:epidemiology* / Q000209:etiology / Q000235:genetics; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D004781:Environmental Exposure / Q000009:adverse effects* / Q000032:analysis; D004784:Environmental Monitoring; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008168:Lung / Q000503:physiopathology; D009608:Nitrous Acid / Q000009:adverse effects / Q000032:analysis; D010126:Ozone / Q000009:adverse effects / Q000032:analysis; D012111:Residence Characteristics; D012140:Respiratory Tract Diseases / Q000150:complications / Q000453:epidemiology* / Q000235:genetics; D012621:Seasons; D012720:Severity of Illness Index
chemical_list: D000393:Air Pollutants; D010126:Ozone; D009608:Nitrous Acid