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Only a few studies have been carried out on the health effects of air pollution on patients suffering from severe asthma. We wanted to test the sensitivity of these patients to Paris air pollution. During 13 months, 60 severe asthmatics (62- female; mean age 55 years) were monitored by their physician, who filled in a follow-up form at each consultation and reported any asthma attacks. Daily levels of SO(2), PM10, NO(2), and O(3) were provided by the air quality network. Statistical analysis (generalized estimating equation models that accounted for autocorrelation of responses, temporal, meteorological, and aerobiological variables, and some individual characteristics) revealed significant associations between PM10, O(3), and incident asthma attacks. Odds Ratio (OR) for an increase of 10 microg/m(3) of PM10 was 1.41; 95% confidence interval (CI) [1.16; 1.71]. An increase of 10 microg/m(3) of O(3) was significantly associated with asthma attacks; OR=1.20; 95% CI [1.03; 1.41]. These relations were observed after a delay between exposure and asthma attacks of 3 to 5 days for PM10 and 2 days for O(3), and they tended to differ according to atopic status. The results of our study suggest that ambient Paris levels of PM10 and O(3) affected health of severe asthmatics, despite their treatment.

Few studies have been conducted on the effects of air pollution on patients with chronic obstructive pulmonary disease (COPD). During a 14-mo period, 39 Parisian adults with severe COPD were monitored by their physicians. Daily levels of 4 air pollutants were provided by an urban air-quality network. Exacerbation of COPD was associated only with ozone (O3) (odds ratio [OR] = 1.44 for a 10-μg/m3 increase in O3; 95% confidence interval [Cl] = 1.14, 1.82), with a lag of 2-3 days. The effect of O3 was greater in patients whose carbon dioxide pressure (PaCO2) was higher than 43 mm Hg (OR = 1.83; 95% Cl = 1.36, 2.47) vs. those with a lower PaCO2 (OR = 1.26; 95% Cl = 0.90, 1.77). The effect of O3 was unchanged, regardless of the maintenance medications used. The only air pollutant to which patients with severe COPD were particularly sensitive was O3.