Association between the Ratio of FEV(1) to FVC and the Exposure Level to Air Pollution in Neversmoking Adult Refractory Asthmatics Using Data Clustered by Patient in the Soonchunhyang Asthma Cohort Database

Using real-world cases, asthma-related clinical data were clustered by patient; 5% of all asthmatics were found to have refractory asthma (RA) with a relatively low lung function (forced expiratory volume in 1 s/forced vital capacity (FEV(1)/FVC) less than 80%). Using a multilevel study design for clustered spirometry data observed between 2005 and 2014, we evaluated the association between changes in the ratio of FEV(1) to FVC and variations in acute exposure to air pollution. We analyzed 2310 episodes of RA from 214 neversmoking patients. In spring, a 1 µg/m³ increase in concentration of particles ≤10 μm (PM(10)) on Lag 1 significantly reduced the ratio by 0.4% (95% confidence interval (CI): 0.1–0.7%) after adjusting for sex, age, body mass index (BMI), and total Immunoglobulin E (IgE) level. Unit (ppb) increase in SO(2) concentration on Lag 3 and 4 in fall and on Lag 6 in winter significantly reduced the ratio by 2 to 3% (p < 0.05). We found that acute exposure to PM(10) in spring or SO(2) in fall or winter were positively associated with lung function drop indicating necessity of control strategies of target air pollutant source by season to protect susceptible population.