Association between cold weather, influenza infection, and asthma exacerbation in adults in Hong Kong

Despite a conspicuous exacerbation of asthma among patients hospitalized due to influenza infection, no study has attempted previously to elucidate the relationship between environmental factors, influenza activity, and asthma si-multaneously in adults. In this study, we examined this relationship using population-based hospitalization records over 22 years. Daily numbers of hospitalizations due to asthma in adults of 41 public hospitals in Hong Kong during 1998-2019 were obtained. The data were matched with meteorological records and air pollutant concentrations. We used type-specific and all-type influenza-like illness plus (ILI+) rates as proxies for seasonal influenza activity. Quasi-Poisson generalized additive models together with distributed-lag non-linear models were used to examine the association. A total of 212,075 hospitalization episodes due to asthma were reported over 22 years. The cumulative adjusted relative risk (ARR) of asthma hospitalizations reached 1.15 (95 % confidence interval [CI], 1.12-1.18) when the ILI+ total rate increased from zero to 20.01 per 1000 consultations. Compared with the median temperature, a significantly increased risk of asthma hospitalization (cumulative ARR = 1.10, 95 % CI, 1.05-1.15) was observed at the 5th percentile of temperature (i.e., 14.6 degrees C). Of the air pollutants, oxidant gas was significantly associated with asthma, but only at its extreme level of concentrations. In conclusion, cold conditions and influenza activities are risk factors to asthma exacerbation in adult population. Influenza-related asthma exacerbation that appeared to be more common in the warm and hot season, is likely to be attributable to influenza A/H3N2. The heavy influence of both determinants on asthma activity implies that climate change may complicate the asthma burden.