The effects of indoor environmental exposures on pediatric asthma: a discrete event simulation modelReport as inadecuate




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Environmental Health

, 11:66

First Online: 18 September 2012Received: 06 December 2011Accepted: 06 September 2012DOI: 10.1186-1476-069X-11-66

Cite this article as: Fabian, M.P., Stout, N.K., Adamkiewicz, G. et al. Environ Health 2012 11: 66. doi:10.1186-1476-069X-11-66

Abstract

BackgroundIn the United States, asthma is the most common chronic disease of childhood across all socioeconomic classes and is the most frequent cause of hospitalization among children. Asthma exacerbations have been associated with exposure to residential indoor environmental stressors such as allergens and air pollutants as well as numerous additional factors. Simulation modeling is a valuable tool that can be used to evaluate interventions for complex multifactorial diseases such as asthma but in spite of its flexibility and applicability, modeling applications in either environmental exposures or asthma have been limited to date.

MethodsWe designed a discrete event simulation model to study the effect of environmental factors on asthma exacerbations in school-age children living in low-income multi-family housing. Model outcomes include asthma symptoms, medication use, hospitalizations, and emergency room visits. Environmental factors were linked to percent predicted forced expiratory volume in 1 second FEV1%, which in turn was linked to risk equations for each outcome. Exposures affecting FEV1% included indoor and outdoor sources of NO2 and PM2.5, cockroach allergen, and dampness as a proxy for mold.

ResultsModel design parameters and equations are described in detail. We evaluated the model by simulating 50,000 children over 10 years and showed that pollutant concentrations and health outcome rates are comparable to values reported in the literature. In an application example, we simulated what would happen if the kitchen and bathroom exhaust fans were improved for the entire cohort, and showed reductions in pollutant concentrations and healthcare utilization rates.

ConclusionsWe describe the design and evaluation of a discrete event simulation model of pediatric asthma for children living in low-income multi-family housing. Our model simulates the effect of environmental factors combustion pollutants and allergens, medication compliance, seasonality, and medical history on asthma outcomes symptom-days, medication use, hospitalizations, and emergency room visits. The model can be used to evaluate building interventions and green building construction practices on pollutant concentrations, energy savings, and asthma healthcare utilization costs, and demonstrates the value of a simulation approach for studying complex diseases such as asthma.

KeywordsAsthma Simulation Indoor Housing Air pollution Lung function Allergen Green building AbbreviationsBMCHPBoston Medical Center Health Net Plan

CAMPChildhood Asthma Management Program

CDCCenters for Disease Control and Prevention

COPDchronic obstructive pulmonary disease

ERemergency room

ETSenvironmental tobacco smoke

FEF25-75%forced expiratory flow from the 25 percentile to the 75 percentile of FVC

FEV1forced expiratory volume in 1 second

FEV1%percent predicted forced expiratory volume in 1 second

FVCforced vital capacity

HPHIHealthy Public Housing Initiative

NHLBINational Heart, Lung and Blood Institute

NO2Nitrogen dioxide

O3Ozone

PEFPeak expiratory flow

ppbParts per billion

RHRelative humidity

SARESevere asthma-related event

SEStandard error.

Electronic supplementary materialThe online version of this article doi:10.1186-1476-069X-11-66 contains supplementary material, which is available to authorized users.

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Author: M Patricia Fabian - Natasha K Stout - Gary Adamkiewicz - Amelia Geggel - Cizao Ren - Megan Sandel - Jonathan I Levy

Source: https://link.springer.com/







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