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Original research
Long-term exposure to ambient air pollution and asthma symptom score in the CONSTANCES cohort
  1. Marion Keirsbulck1,
  2. Marine Savouré1,2,
  3. Emeline Lequy3,
  4. Jie Chen4,
  5. Kees de Hoogh5,6,
  6. Danielle Vienneau5,6,
  7. Marcel Goldberg3,
  8. Marie Zins3,
  9. Nicolas Roche1,7,
  10. Rachel Nadif1,
  11. Benedicte Jacquemin8
  1. 1Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Equipe d’Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France
  2. 2Agence de l’environnement et de la Maîtrise de l’Energie, Angers, France
  3. 3Université Paris-Saclay, UVSQ, Inserm, Cohortes Epidémiologiques en population, Villejuif, France
  4. 4Institute for Risk Assessment Sciences, IRAS, Univ Utrecht, Utrecht, The Netherlands
  5. 5Swiss Tropical and Public Health Institute, Basel, Switzerland
  6. 6University of Basel, Basel, Switzerland
  7. 7Pneumologie, Hôpital Cochin, APHP Centre – Université de Paris, Institut Cochin (UMR 1016), Paris, France
  8. 8Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
  1. Correspondence to Dr Benedicte Jacquemin, IRSET, Rennes 35000, Bretagne, France; benedicte.jacquemin{at}inserm.fr

Abstract

Background The asthma symptom score allows to consider asthma as a continuum and to investigate its risk factors. One previous study has investigated the association between asthma score and air pollution and only for nitrogen dioxide (NO2). We aimed to study the associations between particulate matter with an aerodynamic diameter lower than 2.5 µm (PM2.5), black carbon (BC) and NO2 and the asthma symptom score in adults from CONSTANCES, a French population-based cohort.

Methods Asthma symptom score (range: 0–5) was based on the number of five self-reported symptoms of asthma in the last 12 months. Annual individual exposure to PM2.5, BC and NO2 was estimated at participants’ residential address using hybrid land-use regression models. Cross-sectional associations of each pollutant with asthma symptom score were estimated using negative binomial regressions adjusted for age, sex, smoking status and socioeconomic position. Associations with each symptom were estimated using logistic regression. The effect of BC independent of total PM2.5 was investigated with a residual model.

Results Analyses were conducted on 135 165 participants (mean age: 47.2 years, 53.3% women, 19.0% smokers, 13.5% ever asthma). The ratio of mean score was 1.12 (95% CI 1.10 to 1.14), 1.14 (95% CI 1.12 to 1.16) and 1.12 (95% CI 1.10 to 1.14) per one IQR increase of PM2.5 (4.86 µg/m3), BC (0.88 10−5 m−1) and NO2 (17.3 µg/m3). Positive and significant associations were also found for each asthma symptom separately. BC effect persisted independently of total PM2.5.

Conclusion Exposure to each pollutant was associated with increased asthma symptom score in adults. This study highlights that BC could be one of the most harmful particulate matter components.

  • asthma
  • asthma epidemiology

Data availability statement

Data may be obtained from a third party and are not publicly available. French or foreign research teams wishing to make use of the CONSTANCES cohort infrastructure must submit an application. Projects may only use the available data or biological materials and/or collect additional data for a specific purpose. Cohort data access applications are submitted in the context of a permanent call for proposals (CFPs). Access to the infrastructure is governed by the CONSTANCES Charter, which specifies the rights and responsibilities of the research teams whose projects have been accepted. Applicants are invited to draft a scientific protocol of their research project specifying the scientific objectives, the method, the expected results, the data requested (and the justification for their use) and, if applicable, the elements related to the additional data collection envisaged. The projects are then examined by the CONSTANCES International Scientific Committee and where applicable by its Ethics Review Board; authorisations are issued by the Institutional Steering Committee, which comprised CONSTANCES partner organisations. Applications must be submitted to the French legal authority for personal data processing before the required data are sent to the researcher in charge of the project. These steps must be carried out in close collaboration with the PI of CONSTANCES. For further information: https://www.constances.fr/conduct-project-ongoing.php.

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Data availability statement

Data may be obtained from a third party and are not publicly available. French or foreign research teams wishing to make use of the CONSTANCES cohort infrastructure must submit an application. Projects may only use the available data or biological materials and/or collect additional data for a specific purpose. Cohort data access applications are submitted in the context of a permanent call for proposals (CFPs). Access to the infrastructure is governed by the CONSTANCES Charter, which specifies the rights and responsibilities of the research teams whose projects have been accepted. Applicants are invited to draft a scientific protocol of their research project specifying the scientific objectives, the method, the expected results, the data requested (and the justification for their use) and, if applicable, the elements related to the additional data collection envisaged. The projects are then examined by the CONSTANCES International Scientific Committee and where applicable by its Ethics Review Board; authorisations are issued by the Institutional Steering Committee, which comprised CONSTANCES partner organisations. Applications must be submitted to the French legal authority for personal data processing before the required data are sent to the researcher in charge of the project. These steps must be carried out in close collaboration with the PI of CONSTANCES. For further information: https://www.constances.fr/conduct-project-ongoing.php.

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Footnotes

  • MK and MS are joint first authors.

  • RN and BJ are joint senior authors.

  • MK and MS contributed equally.

  • RN and BJ contributed equally.

  • Contributors MK, MS: conceptualisation, methodology, formal analysis, writing - original draft, visualisation. EL: methodology, resources, writing - review and editing. JC, KdH, DV: methodology, resources, writing - review and editing. MG, MZ: resources, writing - review and editing. NR: writing - review and editing. RN, BJ: conceptualisation, methodology, guarantor, writing - review and editing, supervision.

  • Funding The CONSTANCES cohort study was supported and funded by the French National Health Insurance Fund ('Caisse nationale d'assurance maladie', CNAM). The CONSTANCES cohort study is an 'Infrastructure nationale en Biologie et Santé' and benefits from a grant from the French National Agency for Research (ANR-11-INBS-0002). CONSTANCES is also partly funded by Merck Sharp & Dohme (MSD), AstraZeneca, Lundbeck and L’Oréal. None of these funding sources had any role in the design of the study, collection and analysis of data, or decision to publish.

  • Competing interests NR declares relevant financial activities outside the submitted work: grants or contract from GSK, Boehringer Ingelheim, Pfizer and Novartis in the past 36 months, and relationship with Boehringer Ingelheim, Novartis, Pfizer, Teva, GSK, AstraZeneca, Chiesi, Sanofi and Zambon for consulting fees and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events in the past 36 months.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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