The relationship between day-to-day changes in asthma severity and combined exposures to community air pollutants and aeroallergens remains to be clearly defined. We examined the effects of outdoor air pollutants, fungi, and pollen on asthma. Twenty-two asthmatics ages 9-46 years were followed for 8 weeks (9 May-3 July 1994) in a semirural Southern California community around the air inversion base elevation (1,200 ft). Daily diary responses included asthma symptom severity (6 levels), morning and evening peak expiratory flow rates (PEFR), and as-needed beta-agonist inhaler use. Exposures included 24-hr outdoor concentrations of fungi, pollen, and particulate matter with a diameter < 10 microns (PM10; maximum = 51 micrograms/m3) and 12-hour day-time personal ozone (O3) measurements (90th percentile = 38 ppb). Random effects longitudinal regression models controlled for autocorrelation and weather. Higher temperatures were strongly protective, probably due to air conditioning use and diminished indoor allergens during hot, dry periods. Controlling for weather, total fungal spore concentrations were associated with all outcomes: per minimum to 90th percentile increase of nearly 4,000 spores/m3, asthma symptom scores increased 0.36 (95% CI, 0.16-0.56), inhaler use increased 0.33 puffs (95% CI, -0.02-0.69), and evening PEFR decreased 12.1 l/min (95% CI, -1.8-22.3). These associations were greatly enhanced by examining certain fungal types (e.g., Alternaria, basidiospores, and hyphal fragments) and stratifying on 16 asthmatics allergic to tested deuteromycete fungi. There were no significant associations to low levels of pollen or O3, but inhaler use was associated with PM10 (0.15 inhaler puffs/10 micrograms/m3; p < 0.02). These findings suggest that exposure to fungal spores can adversely effect the daily respiratory status of some asthmatics.ImagesFigure 1.

The relationship between day-to-dy changes The present study was designed to investigate the potential interactive and independent effects of ozone (03) and outdoor aeroallergens (pollens and molds) on daily asthma severity. This was carried out using the panel study design, which is characterized by longitudinal analyses of daily data for a panel of asthmatics, with each subject acting as his or her own control. This study was conducted in the small Southern California community of Alpine, California, over an 8-week period from 9 May through 3 July 1994. The time period was selected to maximize both 03 and fungal spore exposures, and followed the peak spring pollen season for the area. This study represents

Author contributions. LSA, REI and PCS conceived of and designed the study. PCS and IWF conducted chemical analysis of pollen and synthesized spermidines. AEF, RLM, PRA, LMC, PMD, and SL carried out bioassay experiments. AEF analyzed data and prepared figures. LSA wrote the manuscript with substantial contributions from PCS. All co-authors read and provided feedback on the manuscript.

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