Helping pediatric asthma patients breathe easier by avoiding lengthy hospital stays

School of Public Health student investigates how outdoor air pollution affects asthma patients and health care costs
June 25, 2020

Lengthy hospital stays contribute to the spiraling cost of health care in the United States. For pediatric asthma patients—whose caregivers already pay an average annual cost of nearly $1,000 to control their child’s asthma—avoiding prolonged hospital stays is of particular interest.

According to the Centers for Disease Control and Prevention (CDC), asthma is a disease that affects your lungs and can cause repeated episodes of wheezing, breathlessness, chest tightness and coughing. Every year, about 1 in 20 children is hospitalized for asthma. Asthma can be controlled by taking medicine and avoiding triggers that can cause an asthma attack, such as tobacco smoke and pet dander. However, some triggers that are ubiquitous in the environment, such as air pollution, can be especially difficult to avoid. Exposure to air pollution, even in the short term, can cause asthma attacks and potentially prolonged hospital stays for pediatric asthma patients, ultimately contributing to the spiraling cost of health care.

Juha Baek, a doctoral candidate in the Department of Environmental and Occupational Health at the Texas A&M School of Public Health, is working to clarify this potentially important relationship between outdoor air pollution and pediatric asthma patients’ hospital length of stay. Identifying factors that affect hospital length of stay in pediatric asthma patients is important to improve health outcomes and effective use of health care resources, which can help reduce the cost of health care.

Baek and colleagues’ recently published study in the International Journal of Environmental Research and Public Health included data gathered from 711 children aged 5 to 18 years old who were admitted for asthma to a pediatric care hospital in South Texas from 2010 to 2014. Air pollution data for two major air pollutants were collected from the CDC for the same time period and were cross analyzed with the patients’ data.

After controlling for other confounding factors that may also affect hospital length of stay, such as preexisting conditions, the results ultimately revealed a positive association between ground-level ozone pollution and prolonged hospital stays in pediatric asthma patients of all ages. Additionally, hospital length of stay for children aged 5 to 11 years old was significantly affected by particulate matter pollution—tiny particles that can easily be inhaled. Research suggests that younger children are more vulnerable to respiratory effects of air pollution because they are still in developmental stages.

The results of the study are concerning, especially since the study location did not show a high level of outdoor air pollution in general. “I found the adverse effects of outdoor air pollutants on hospital length of stay surprising since it implies that ambient air pollution may contribute to prolonged hospital stays even in regions with relatively low level of air pollution,” Baek said.

Additionally, the results suggest that the importance of outdoor air pollution on asthma control and management should be emphasized in asthma education. “Our health is intricately and inevitably related to what we are exposed to in the environment,” Baek said. “Children with asthma could be more negatively affected by indoor and outdoor air conditions around them. For example, children with asthma living in places with high air pollution levels are more likely to be exposed to air pollutants, which could worsen their asthma condition and cause asthma attacks.”

The results also serve as evidence for policies related to air pollution control and improved health care resource allocation and utilization, in that health care providers should focus on care for children from regions with high levels of air pollution to decrease hospital length of stay.

There is much more to explore regarding the relationship between air pollution and hospital length of stay for pediatric asthma patients, including how hospital length of stay is affected by higher levels of air pollution, such as in metropolitan areas.

– by Callie Rainosek

— Rae Lynn Mitchell

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