Environmental factors and asthma hospitalization in Montreal, Canada, during spring 2006–2008: a synergy perspective

Abstract

The aim of this study is to analyze the synergy between environmental factors (pollutant, allergenic birch pollen, weather) and its relationship with asthma hospitalization in Montreal, Canada. The data is stratified into weather types and the study restricted to spring season to limit the impact of multiple confounders. Results shows that the daily count of asthma hospitalization (spring 2006–2008) in situation of warm fronts or trowals (daily average of 3.78 counts, CI 95% 2.95–4.61) was much higher (p < 0.001) than in other situations (2.49 counts, CI 95% 2.37–2.71). Moreover, the explained variance of asthma hospitalization due to air pollution rises from about less than 7% (in the case of no stratification) to about 28% (R = 0.53, p < 0.05 with stratification). Statistical tests for interaction and overall results point towards a synergy between environmental factors which exacerbates asthma. A new concept named frontal asthma is proposed to explain several results found here and in the open literature.