title: Poor asthma control and exposure to traffic pollutants and obesity in older adults.
abstract: BACKGROUND
  Environmental and host predictors of asthma control in older asthmatic patients (>65 years old) are poorly understood.
  
  
  OBJECTIVE
  To examine the effects of residential exposure to traffic exhaust and other environmental and host predictors on asthma control in older adults.
  
  
  METHODS
  One hundred four asthmatic patients 65 years of age or older from allergy and pulmonary clinics in greater Cincinnati, Ohio, completed the validated Asthma Control Questionnaire (ACQ), pulmonary function testing, and skin prick testing to 10 common aeroallergens. Patients had a physician's diagnosis of asthma, had significant reversibility in forced expiratory volume in 1 second or a positive methacholine challenge test result, and did not have chronic obstructive pulmonary disease. The mean daily residential exposure to elemental carbon attributable to traffic (ECAT) was estimated using a land-use regression model. Regression models were used to evaluate associations among independent variables, ACQ scores, and the number of asthma exacerbations, defined as acute worsening of asthma symptoms requiring prednisone use, in the past year.
  
  
  RESULTS
  In the adjusted model, mean daily residential exposure to ECAT greater than 0.39 μg/m(3) was significantly associated with poorer asthma control based on ACQ scores (adjusted β = 2.85; 95% confidence interval [CI], 0.58-5.12; P = .02). High ECAT levels were also significantly associated with increased risk of asthma exacerbations (adjusted odds ratio, 3.24; 95% CI, 1.01-10.37; P = .05). A significant association was found between higher body mass index and worse ACQ scores (adjusted β = 1.15; 95% CI, 0.53-1.76; P < .001). Atopic patients (skin prick test positive) had significantly better ACQ scores than nonatopic patients (adjusted β = -0.39; 95% CI, -0.67 to -0.11; P < .01).
  
  
  CONCLUSIONS
  Higher mean daily residential exposure to traffic exhaust, obesity, and nonatopic status are associated with poorer asthma control among older asthmatic patients.
authors.affiliation: Department of Medicine, Division of Immunology, Allergy and Rheumatology, University of Cincinnati College of Medicine, 3255 Eden Ave. no. 350, Cincinnati, OH 45267, USA. epsteite@uc.edu
authors.forename: Tolly G
authors.initials: TG
authors.lastname: Epstein
authors.forename: Patrick H
authors.initials: PH
authors.lastname: Ryan
authors.forename: Grace K
authors.initials: GK
authors.lastname: LeMasters
authors.forename: Cheryl K
authors.initials: CK
authors.lastname: Bernstein
authors.forename: Linda S
authors.initials: LS
authors.lastname: Levin
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Bernstein
authors.forename: Manuel S
authors.initials: MS
authors.lastname: Villareal
authors.forename: David I
authors.initials: DI
authors.lastname: Bernstein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000393:Air Pollutants / Q000276:immunology*; D000485:Allergens / Q000276:immunology; D001249:Asthma / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology*; D015992:Body Mass Index; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology*; D009820:Ohio / Q000453:epidemiology; D012044:Regression Analysis; D012129:Respiratory Function Tests; D012307:Risk Factors; D012882:Skin Tests; D011795:Surveys and Questionnaires; D001335:Vehicle Emissions
chemical_list: D000393:Air Pollutants; D000485:Allergens; D001993:Bronchodilator Agents; D001335:Vehicle Emissions